Back to the future
Today's New York Times brings us an op-ed from Clinton-era FDA apparatchik David G. Adams arguing the need for "A Two Cigarette Society": that is, the introduction of cigarettes with little to no nicotine. This innovation is necessary to limit the harm done by underage smoking, an activity that Adams argues is initiated by the self-reinforcing need-to-fit-in/peer pressure tandem, but becomes a habit long outlasting the faddishness of adolescence owing to the highly addictive nature of the nicotine concentrations present in cigarettes. Adams believes that the regulatory will isn't there to force cigarette manufacturers to reduce nicotine in all cigarettes, but that by essentially bifurcating the cigarette market - that is, prohibiting the sale of nicotine-laden cigarettes to people born after a certain date - we can filter down the numbers of people exposed to "addictive" cigarettes, making quitting a simpler matter and eliminating a lot of the long-term health issues associated with smoking.
Having quit smoking and lived to tell the tale, I empathize with Mr. Adams' main point: kids are going to smoke anyway, but if we started them off on cigarettes without nicotine, far more of them could quit before doing any longterm damage to their health. However, I think that there are several drawbacks to such a scheme, not least of all that it runs contrary to existing, and I think, successful, public health policy. For the past twenty years, the federal and state governments have largely pursued a three-pronged approach to reducing smoking: increasing public awareness of the health risks associated with smoking, banning smoking from places of public accommodation, and increasing taxes on tobacco products. All reliable statistical indicators have suggested that this approach works: far fewer people smoke today than did even fifteen years ago, and states that apply the most aggressive approaches usually see results commensurate with those efforts.
(A side note: it sure was sad that all of the restaurants and bars in New Jersey went out of business after the Legislature banned smoking indoors. I remember when you used to not have to go to Pennsylvania for a steak or a beer - oh wait, that's right, none of that happened. At all. Thank God we dodged that bullet.)
By mandating the introduction of nicotine-free cigarettes, however, government would be playing into the "safe" cigarette illusion, giving its tacit imprimatur to smoking. Fear of addiction plays a large part in the current avoidance model; by removing or reducing that fear, we could be encouraging more young people to pick up smoking casually. It would by naive to think that tobacco companies, with one foot already in the door, would abstain from trying to tempt this potentially lucrative new market into switching over to addictive nicotine-containing cigarettes. Furthermore, reduced nicotine levels might lead to a net longterm reduction in exposure to the hazardous aspects of smoking, but it would not remove those hazards; in fact, by potentially increasing the number of people willing to smoke in the short term, Adams' proposal could inadvertently increase the numbers of people exposed to secondhand smoke.
What is most interesting to me about Adams' piece is what it doesn't propose, or even mention in passing: why not ban the manufacture and sale of cigarettes? There are the obvious reasons, that people trot out, which usually run the gamut from personal choice ("it's a free country") to economics (in many states, such as Virginia, Kentucky, and the Carolinas, Big Tobacco remains a major employer) to the perils of outright prohibition (we don't want another War on Drugs, do we?). Admittedly, these are compelling points, and they form the basis of Adams' underlying assumption that even taking such a mild step as mandating an across-the-board reduction in nicotine is politically impossible.
Yet, while implementing a ban today is probably unfeasible, mentioning one is also seemingly verboten; rarely, if at all, do you see high profile discussion of such proposals, even hypothetically. Imagine a pro-life movement committed to restricting women's access to abortion clinics but virtually mum on the idea of making the procedure completely illegal. Such a thing would be absurd, but it is that same lack of totality that may be the defining feature of America's anti-smoking movement. Indeed, even among people most ardently opposed to smoking, it seems like conceiving of a world without cigarettes simply requires too great a leap of the imagination to be reasonably discussed. Most have an accommodationist point of view: as long as you don't smoke around me, I don't care what you do. Ostracization, as opposed to eradication.
The "you're only harming yourself" point of view, however, fails to account for the actual social and economic costs of smoking. Smokers are generally more unhealthy than non-smokers, and as a result they miss, on average, far more time from work due to sickness. Being more prone to illness, they also tend to require medical care more routinely, thus contributing to an overall increase in insurance premiums that effects non-smokers as well. As they get older, they are far more susceptible to wide range of debilitating health conditions, including heart attack, stroke, emphysema, and, of course, a cornucopia of cancers. This costs programs like Medicare millions if not billions of dollars - your tax dollars - annually. That's not factoring in the additional expenses incurred by family members and other assorted caregivers, nor the high levels of emotional duress those people experience as their loved ones are rendered completely incapable of fending for themselves.
Furthermore, the question of banning smoking has a moral dimension as well: should the government permit the sale of a product, that as a matter of its routine and proper use, invariably damages the health of the end user? After all, we prohibit the sale of recreational drugs such as a cocaine, heroin, and marijuana on the grounds that they pose a public health risk. Why shouldn't the same logic be applied to the deleterious impact of cigarette smoking? That smoking kills is not the subject of much dispute nowadays; anyone exposed to a gangrenous foot or a clogged carotid artery courtesy of the New York City Department of Health while enjoying a Mets game on SNY can attest to that. It is vaguely ridiculous that we spend millions on advertising the ill effects of tobacco and setting up quitlines, and yet you can walk into any convenience store in your neighborhood and buy a pack of cigarettes.
(Allow me to head you off at the pass, Mr. What-About-Big Macs-and-Booze? Yes, alcohol and fatty foods can be dangerous to your health. However, both of these things can be enjoyed safely in moderation; having been a pack-a-day smoker I can tell you that "moderation", for the most part, simply doesn't exist when it comes to cigarettes. Furthermore, several jurisdictions have already taken steps to reduce consumption of harmful foods: New York City has banned the use of trans fats in restaurants, and several states have banned or otherwise restricted the sale of junk foods and sodas from school cafeterias. So there.)
Ultimately, though I believe that smoking will continue to become more and more marginalized, I don't think that we will see an outright ban on cigarettes anytime in the near future. Instead, I predict an intensification of the current regime: smoking will be reduced by attrition as increasingly alarmist propaganda (seriously, gangrene?), exorbitant taxes ($9.00 a pack in NYC), and greater restrictions (bans on smoking in rental units? households with minors?) all continue to proliferate. It's a curious mirroring of the "avoision" phenomenon taking place in the legal sphere; instead of circumventing existing outmoded laws, we'll be affecting a ban on smoking in everything but name only. Unless it becomes practical to pay $30 for a pack of cigarettes that you can only smoke in a sealed room in your home (complete with its own isolated ventilation system) while running the risk of spontaneous facial rot, that is.
Having quit smoking and lived to tell the tale, I empathize with Mr. Adams' main point: kids are going to smoke anyway, but if we started them off on cigarettes without nicotine, far more of them could quit before doing any longterm damage to their health. However, I think that there are several drawbacks to such a scheme, not least of all that it runs contrary to existing, and I think, successful, public health policy. For the past twenty years, the federal and state governments have largely pursued a three-pronged approach to reducing smoking: increasing public awareness of the health risks associated with smoking, banning smoking from places of public accommodation, and increasing taxes on tobacco products. All reliable statistical indicators have suggested that this approach works: far fewer people smoke today than did even fifteen years ago, and states that apply the most aggressive approaches usually see results commensurate with those efforts.
(A side note: it sure was sad that all of the restaurants and bars in New Jersey went out of business after the Legislature banned smoking indoors. I remember when you used to not have to go to Pennsylvania for a steak or a beer - oh wait, that's right, none of that happened. At all. Thank God we dodged that bullet.)
By mandating the introduction of nicotine-free cigarettes, however, government would be playing into the "safe" cigarette illusion, giving its tacit imprimatur to smoking. Fear of addiction plays a large part in the current avoidance model; by removing or reducing that fear, we could be encouraging more young people to pick up smoking casually. It would by naive to think that tobacco companies, with one foot already in the door, would abstain from trying to tempt this potentially lucrative new market into switching over to addictive nicotine-containing cigarettes. Furthermore, reduced nicotine levels might lead to a net longterm reduction in exposure to the hazardous aspects of smoking, but it would not remove those hazards; in fact, by potentially increasing the number of people willing to smoke in the short term, Adams' proposal could inadvertently increase the numbers of people exposed to secondhand smoke.
What is most interesting to me about Adams' piece is what it doesn't propose, or even mention in passing: why not ban the manufacture and sale of cigarettes? There are the obvious reasons, that people trot out, which usually run the gamut from personal choice ("it's a free country") to economics (in many states, such as Virginia, Kentucky, and the Carolinas, Big Tobacco remains a major employer) to the perils of outright prohibition (we don't want another War on Drugs, do we?). Admittedly, these are compelling points, and they form the basis of Adams' underlying assumption that even taking such a mild step as mandating an across-the-board reduction in nicotine is politically impossible.
Yet, while implementing a ban today is probably unfeasible, mentioning one is also seemingly verboten; rarely, if at all, do you see high profile discussion of such proposals, even hypothetically. Imagine a pro-life movement committed to restricting women's access to abortion clinics but virtually mum on the idea of making the procedure completely illegal. Such a thing would be absurd, but it is that same lack of totality that may be the defining feature of America's anti-smoking movement. Indeed, even among people most ardently opposed to smoking, it seems like conceiving of a world without cigarettes simply requires too great a leap of the imagination to be reasonably discussed. Most have an accommodationist point of view: as long as you don't smoke around me, I don't care what you do. Ostracization, as opposed to eradication.
The "you're only harming yourself" point of view, however, fails to account for the actual social and economic costs of smoking. Smokers are generally more unhealthy than non-smokers, and as a result they miss, on average, far more time from work due to sickness. Being more prone to illness, they also tend to require medical care more routinely, thus contributing to an overall increase in insurance premiums that effects non-smokers as well. As they get older, they are far more susceptible to wide range of debilitating health conditions, including heart attack, stroke, emphysema, and, of course, a cornucopia of cancers. This costs programs like Medicare millions if not billions of dollars - your tax dollars - annually. That's not factoring in the additional expenses incurred by family members and other assorted caregivers, nor the high levels of emotional duress those people experience as their loved ones are rendered completely incapable of fending for themselves.
Furthermore, the question of banning smoking has a moral dimension as well: should the government permit the sale of a product, that as a matter of its routine and proper use, invariably damages the health of the end user? After all, we prohibit the sale of recreational drugs such as a cocaine, heroin, and marijuana on the grounds that they pose a public health risk. Why shouldn't the same logic be applied to the deleterious impact of cigarette smoking? That smoking kills is not the subject of much dispute nowadays; anyone exposed to a gangrenous foot or a clogged carotid artery courtesy of the New York City Department of Health while enjoying a Mets game on SNY can attest to that. It is vaguely ridiculous that we spend millions on advertising the ill effects of tobacco and setting up quitlines, and yet you can walk into any convenience store in your neighborhood and buy a pack of cigarettes.
(Allow me to head you off at the pass, Mr. What-About-Big Macs-and-Booze? Yes, alcohol and fatty foods can be dangerous to your health. However, both of these things can be enjoyed safely in moderation; having been a pack-a-day smoker I can tell you that "moderation", for the most part, simply doesn't exist when it comes to cigarettes. Furthermore, several jurisdictions have already taken steps to reduce consumption of harmful foods: New York City has banned the use of trans fats in restaurants, and several states have banned or otherwise restricted the sale of junk foods and sodas from school cafeterias. So there.)
Ultimately, though I believe that smoking will continue to become more and more marginalized, I don't think that we will see an outright ban on cigarettes anytime in the near future. Instead, I predict an intensification of the current regime: smoking will be reduced by attrition as increasingly alarmist propaganda (seriously, gangrene?), exorbitant taxes ($9.00 a pack in NYC), and greater restrictions (bans on smoking in rental units? households with minors?) all continue to proliferate. It's a curious mirroring of the "avoision" phenomenon taking place in the legal sphere; instead of circumventing existing outmoded laws, we'll be affecting a ban on smoking in everything but name only. Unless it becomes practical to pay $30 for a pack of cigarettes that you can only smoke in a sealed room in your home (complete with its own isolated ventilation system) while running the risk of spontaneous facial rot, that is.
