Cultivating Clout

Cancer society’s all-out lobbying helps advance tough new anti-tobacco legislation, but critics say role is inappropriate for a charity

The American Cancer Society has been “a little bit outrageous” in its push to pass anti-tobacco legislation in Congress, the charity’s chief lobbyist, Linda Hay Crawford, proudly acknowledges.

In addition to tripling the number of employees in its office here in the past year and a half, the cancer society has set up a “war room” to coordinate daily strategy on tobacco bills with other non-profit groups, conducted public-opinion polls, and paid for a major advertising campaign to try to sway U.S. Senators and Representatives. The cancer society’s national office plans to spend about $1-million this year on “Operation Ignite” and other advocacy efforts, and the charity’s local groups have spent an additional $1-million on lobbying and educational campaigns.

The charity has even joined the Democratic and Republican Governors’ Associations in order to vie with long-time tobacco-industry members for state officials’ time and attention.

“If you are going to do advocacy, you ought to use all the techniques appropriately and legally that your competitors use,” says Ms. Crawford.

The cancer society’s efforts are making a difference on Capitol Hill. Sen. John McCain, Republican of Arizona and a key sponsor of anti-tobacco legislation, praises the group’s work as “invaluable.” He adds: “If tobacco legislation gets passed, it will be in no small part due to their efforts.”

The American Cancer Society hopes its aggressive tactics in the tobacco battle will serve as a blueprint for others involved in future legislative fights.

Ms. Crawford says charities should be lobbying far more than most currently do. “You can do so much,” she says, dismissing common complaints from non-profit groups that they will endanger their charitable tax status or donation income.

The cancer society’s actions, however, have opened it up to criticism. The American Lung Association, for example, charges that the cancer society has made a big mistake by accepting compromises that give some legal protections to the tobacco industry.

And James T. Bennett, an economics professor at George Mason University and co-author of the book CancerScam, contends that charitable organizations should not use tax-deductible donations for lobbying. “Charity and politics are like oil and water — the two don’t mix,” he says. “The American Cancer Society is quickly transforming itself from a true charity to basically another political advocacy group.”

The American Cancer Society’s efforts to influence tobacco legislation represent a major shift for the 85-year-old organization, which only a few years ago added the word “advocacy” to its mission statement.

While the Atlanta charity has long had a Washington office and been a vocal advocate for increased federal spending on cancer research, it was fairly “passive” when it came to other lobbying, explains Jennie R. Cook, chairman of the American Cancer Society’s board.

“Advocacy was something that we talked about and we saw other people doing, but we really did not take a leadership role in it,” she says.

The charity’s lobbying efforts went into overdrive with its campaign to push legislation to severely curb the activities of tobacco companies.

Ms. Cook says that making the transition required lobbying within the organization to win over staff members, trustees, and other volunteers.

“There have been some people who have said, What are you doing in this arena? Why are you even bothering? Wouldn’t this money be better spent on research or education?” says Ms. Cook.

She says the American Cancer Society has been careful to reassure people that its commitment to research and education remains strong. “But our research told us that 30 per cent of all cancers are caused by tobacco use,” she says. “And so consequently we knew that we could probably prevent 30 per cent of all cancers if we could do something right through advocacy.”

Ms. Crawford says the cancer society had no choice but to delve into advocacy if it wanted to be true to its mission of eliminating cancer as a major health problem. “It would be unethical and immoral for the American Cancer Society not to do this, because we have a chance here to protect kids from ever starting to smoke,” she says.

The bill being considered in the Senate would raise the price of cigarettes by $1.10 a pack over five years and generate some $500-billion for efforts to curb youth smoking and to offset medical costs for smoking-related illnesses.

One of the charity’s first steps in pushing for anti-tobacco legislation was to expand its presence in the nation’s capital. In the year and a half since Ms. Crawford was hired, the cancer society has increased its Washington staff from 11 to 31 employees. It also is in the process of filling six additional slots.

Many of those hired have substantial experience in lobbying or political jobs.

Ms. Crawford, for example, has worked for the U.S. Department of Agriculture under the Carter Administration, been a health adviser to former Maryland Gov. William Donald Schaefer, and lobbied in behalf of the Pharmaceutical Research and Manufacturers of America.

Her involvement with the American Cancer Society, however, is as much personal as professional. Her husband, Victor Crawford, died of throat cancer in 1996. A long-time lobbyist for the tobacco companies, Mr. Crawford switched sides before his death to become a leading critic of the industry.

Ms. Crawford says she was persuaded to take the job at the cancer society in part because its chief executive, John R. Seffrin, had such a strong commitment to lobbying.

“He said, ‘I want people to come to us before they even are thinking about putting a bill in. We don’t have that right now,’ ” Ms. Crawford recalls. She says she and Mr. Seffrin set out to change the “condescending approach” many politicians and others had toward charities, coming to them only late in the legislative process to get their stamps of approval.

Making that change has required money. The $1-million budget for the cancer society’s national office represents the maximum amount the organization can spend on direct lobbying and educational expenses without incurring penalties. The charity’s local groups, because they are independent of the national organization, can incur additional lobbying expenses, which so far have totaled about $1-million for anti-tobacco advertisements.

The charity also has played a lead financial role in creating the National Center for Tobacco-Free Kids, an organization that was started in 1996 to fight smoking. The cancer society is giving the center $10-million over five years, a financial commitment surpassed only by a $20-million grant from the Robert Wood Johnson Foundation.

And the cancer society has been instrumental in organizing another coalition — the Effective National Action to Control Tobacco, or ENACT. Money from the cancer society’s lobbying budget pays for the coalition’s “war room,” a ballroom at a Capitol Hill hotel that has been converted into a central lobbying spot for the anti-tobac co movement. Representatives of about 50 non-profit groups gather there at 8:30 a.m. and 5:30 p.m. each day to compare notes and plot strategy.

The American Cancer Society’s own strategy includes an e-mail network that updates local cancer society executives and volunteers on the progress of anti-tobacco legislation and on senators’ and representatives’ positions. “Every night we put a notice with the targets: He voted wrong, get to him. He voted right, praise him,” Ms. Crawford says.

To influence the press, the cancer society has been sending out daily fax updates to about 200 reporters under the heading, “There they go again . . .” to rebut comments from the tobacco industry.

The faxes also go to members of Congress. Charity officials have been making frequent in-person visits to members of Congress as well. One week at the end of April, for instance, a group of cancer society board members made the rounds to 120 Congressional offices.

On such visits, the cancer society arms itself with reports and public-opinion surveys. “We try to think one step ahead,” says Ms. Crawford. For example, the charity commissioned an opinion poll to see how Americans who supported a “No Tax” pledge viewed bills that increased taxes on cigarettes. The organization also published a study on the financial outlook for the tobacco industry to counter arguments that companies would go bankrupt if provisions in current tobacco bills were enacted.

To help get its message out to the public, the cancer society has paid for a professionally designed advertising campaign that features David Kessler, the former head of the Food and Drug Administration, and C. Everett Koop, the former surgeon general. “It’s time to keep the tobacco companies from addicting any more of our children to their deadly products,” the ads state.

Ms. Crawford says the ads were designed to be educational in nature; they deliberately did not call for action or name a specific bill so that they would not have to be counted toward the small amount of direct or “grassroots” lobbying expenses the charity is permitted. A video version aired on CNN for a week last month, while print and radio ads ran in five states, including Ohio, Maine, and Georgia. Ms. Crawford says the charity picked states that were home to members of Congress who play a key role in the debate.

Scott Williams, a spokesman for BSMG Worldwide, which represents the five biggest tobacco companies, says efforts such as the American Cancer Society’s ads are ineffective.

“There’s no substance to them,” he says. “I think people have seen through the fallacy that this is a kids’ smoking bill. It’s a huge tax measure and an effort to advance a lot of political agendas on the back of a disfavored industry.”

Mr. Williams says health groups risk losing credibility when they get involved in issues outside of clear-cut health concerns, such as whether tobacco companies should be afforded liability protection in lawsuits.

Ms. Crawford views such criticism as sour grapes. “The fun part is playing them at their own game,” she says, referring to the tobacco industry. “They have spent years figuring out all these things that they can do, and we’re just coming in and stealing them.”

One strategy the charity has borrowed from corporate lobbyists is to join the Democratic and Republican Governors’ Associations. For the annual $5,000 payment that the cancer society has given to each organization, it gets the opportunity to rub elbows with state governors at annual conferences and other events.

“To be able to go to a meeting where you only have 30 other outsiders and get to sit with somebody for dinner, you build trust,” says Ms. Crawford. “It’s fabulous to go to the same meetings as Philip Morris, which may have spent a quarter of a million dollars funding a golf tournament, and have the same equal access.”

The cancer society says it has been careful to get letters from each governors’ association stating that its membership money would not be used to pay for political activities.

Still, the membership payments “raise a red flag,” says Frances Hill, a University of Miami law professor. The cancer society’s action seems to be perfectly legal, she says. But, Ms. Hill worries, if other charities went one step further, membership dues could become “a nifty way to channel tax-deductible money into political activity,” which would be illegal.

Apart from the tax issues, Ms. Hill says she is also troubled by bigger questions. “Did the can cer society do this because they thought they had to buy access to political circles?” she asks. “If that’s the case, then we need to reform our political process, because neither the cancer society nor any individual should have to buy into representation.”

Ms. Crawford says charities ignore the realities of the political world at their own peril. She says attending meetings of the governors’ associations “puts you in a much different environment than getting a 15-minute appointment with a governor who says, ‘Thank you very much for your recommendations,’ and then throws them out on his way to his office.”

Such no-nonsense views of politics also shape the cancer society’s positions on issues. Ms. Crawford says health charities have been easy targets because in the past they have been perceived as “too strident” or too determined to hold out “for the perfect policy.” She says charities have to “play with the rules Capitol Hill plays with, which means compromise.”

Compromises, however, have pitted the cancer society against some of its colleagues in the anti-tobacco movement, most notably the American Lung Association. The lung association, as well as others who make up the “Save Lives, Not Tobacco” coalition, oppose measures that include lawsuit liability protections for tobacco companies.

“A lot of us think that there’s just no way that you can give the tobacco industry any kind of legal protection,” say John R. Garrison, managing director of the American Lung Association. He criticizes the American Cancer Society and the National Center for Tobacco-Free Kids for being “a little bit naive on this whole thing.”

Ms. Crawford brushes off such criticisms: “My theory is, You push it as far as you can for the right policy — but you don’t put your head in the sand at the beginning. You have to show that you are trustworthy and flexible.”

Whether or not the American Cancer Society succeeds in getting anti-tobacco legislation passed this year, Ms. Crawford wants other charities to benefit from the lessons her organization is learning.

She says much of her time has been eaten up consulting with lawyers to make sure that the cancer society stays within the lobbying limits imposed on charities, even as the group pushes those limits to incorporate new strategies. “We lose a lot of momentum with all of that,” Ms. Crawford says.

Her efforts, she hopes, will pave the way for other charities. “The more people know the rules and have some kind of structure, the more comfortable they are going to feel in doing lobbying.”

Ms. Cook, the cancer society’s board chairman, agrees. But, she warns others, “don’t expect overnight success. And don’t expect it to be a clean fight.”

Ms. Cook says that although charities risk offending donors and others at the start with a high-profile lobbying approach, she believes that the efforts pay off in the long run. “The general public is very forgiving,” she says. “And even if people feel immediately that they don’t like what you’re doing, they will stand by and wait to see what the outcomes are. And if the outcomes are in their favor or successful, then they’re going to support you in it.”

That seems to be the case for the American Cancer Society. It says few donors have complained, and contributions last year rose 14.5 per cent, to $488.5-million.

As the tobacco debate rages on, Ms. Crawford says she is already thinking about ways to push legislation that might fight cancers other than those caused by smoking.

She says the charity has no plans to slow its lobbying efforts. “I was just doing my budget for next year and I put in: The Next Campaign — $1-million.”