Should We Ban Cigarettes?
HEALTH, 21 Nov 2011
Peter Singer – Project Syndicate
US President Barack Obama’s doctor confirmed last month that the president no longer smokes. At the urging of his wife, Michelle Obama, the president first resolved to stop smoking in 2006, and has used nicotine replacement therapy to help him. If it took Obama, a man strong-willed enough to aspire to and achieve the US presidency, five years to kick the habit, it is not surprising that hundreds of millions of smokers find themselves unable to quit.
Although smoking has fallen sharply in the US, from about 40% of the population in 1970 to only 20% today, the proportion of smokers stopped dropping around 2004. There are still 46 million American adult smokers, and smoking kills about 443,000 Americans each year. Worldwide, the number of cigarettes sold – six trillion a year, enough to reach the sun and back – is at an all-time high. Six million people die each year from smoking – more than from AIDS, malaria, and traffic accidents combined. Of the 1.3 billion Chinese, more than one in ten will die from smoking.
Earlier this month, the US Food and Drug Administration announced that it would spend $600 million over five years to educate the public about the dangers of tobacco use. But Robert Proctor, a historian of science at Stanford University and the author of a forthcoming blockbuster entitled Golden Holocaust: Origins of the Cigarette Catastrophe and the Case for Abolition, argues that to use education as one’s only weapon against a highly addictive and often lethal drug is unpardonably insufficient.
“Tobacco control policy,” Proctor says, “too often centers on educating the public, when it should be focused on fixing or eliminating the product.” He points out that we don’t just educate parents to keep toys painted with lead-based paints away from their children’s mouths; we ban the use of lead-based paint. Similarly, when thalidomide was found to cause major birth defects, we did not just educate women to avoid using the drug when pregnant.
Proctor calls on the FDA to use its new powers to regulate the contents of cigarette smoke to do two things. First, because cigarettes are designed to create and maintain addiction, the FDA should limit the amount of nicotine that they contain to a level at which they would cease to be addictive. Smokers who want to quit would then find it easier to do so.
Second, the FDA should bear history in mind. The first smokers did not inhale tobacco smoke; that became possible only in the nineteenth century, when a new way of curing tobacco made the smoke less alkaline. That tragic discovery is already responsible for about 150 million deaths, with many times that toll still to come, unless something drastic is done. The FDA should therefore require that cigarette smoke be more alkaline, which would make it less easily inhaled, and so make it harder for cigarette smoke to reach the lungs.
Much of Proctor’s book, which will be published in January, is based on a vast archive of tobacco-industry documents, released during litigation. More than 70 million pages of industry documents are now available online.
The documents show that, as early as the 1940’s, the industry had evidence suggesting that smoking causes cancer. In 1953, however, a meeting of the chief executives of major American tobacco companies took a joint decision to deny that cigarettes are harmful. Moreover, once the scientific evidence that smoking causes cancer became public, the industry tried to create the impression that the science was inconclusive, in much the same way that those who deny that human activities are causing climate change deliberately distort the science today.
As Proctor says, cigarettes, not guns or bombs, are the deadliest artifacts in the history of civilization. If we want to save lives and improve health, nothing else that is readily achievable would be as effective as an international ban on the sale of cigarettes. (Eliminating extreme poverty worldwide is about the only strategy that might save more lives, but it would be far more difficult to accomplish.)
For those who recognize the state’s right to ban recreational drugs like marijuana and ecstasy, a ban on cigarettes should be easy to accept. Tobacco kills far more people than these drugs.
Some argue that as long as a drug harms only those who choose to use it, the state should let individuals make their own decisions, limiting its role to ensuring that users are informed of the risks that they are running. But tobacco is not such a drug, given the dangers posed by secondhand smoke, especially when adults smoke in a home with young children.
Even setting aside the harm that smokers inflict on nonsmokers, the free-to-choose argument is unconvincing with a drug as highly addictive as tobacco, and it becomes even more dubious when we consider that most smokers take up the habit as teenagers and later want to quit. Reducing the amount of nicotine in cigarette smoke to a level that was not addictive might meet this objection.
The other argument for the status quo is that a ban on tobacco might result in the same kind of fiasco as occurred during Prohibition in the US. That is, like the effort to ban alcohol, prohibiting the sale of tobacco would funnel billions of dollars into organized crime and fuel corruption in law-enforcement agencies, while doing little to reduce smoking.
But that may well be a false comparison. After all, many smokers would actually like to see cigarettes banned because, like Obama, they want to quit.
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Peter Singer is a professor of bioethics at Princeton University and Laureate Professor at the University of Melbourne. His books include Animal Liberation, Practical Ethics, and The Life You Can Save.
Copyright: Project Syndicate, 2011.
Go to Original – project-syndicate.org
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It is very difficult to ban something (such as smoking) which has been a socially (and legally) accepted centuries-old custom. A bunch of research papers have reported the deadly effect of smoking. Most smokers today know how smoking is harmful for their health (and for that of people around them). Nonetheless, people continue smoking.
My concern about the ban on smoking is mentioned in the second paragraph from the bottom in the above essay: “… a ban on tobacco might result in the same kind of fiasco as occurred during Prohibition in the US. That is, like the effort to ban alcohol, prohibiting the sale of tobacco would funnel billions of dollars into organized crime and fuel corruption in law-enforcement agencies, while doing little to reduce smoking.”
The ban on smoking cannot be achieved in one day. The ban on smoking cannot be achieved only by non-smoking campaigns. The ban on smoking cannot be achieved only by the education for health. The ban on smoking cannot be achieved only by introducing a new law to ban smoking. The ban on smoking cannot be achieved only by the powerful law enforcement. The ban on smoking cannot be achieved even by any of these combination(s). The ban on smoking might require decades, a century, or perhaps more, because people cannot change their centuries-old custom in a short period of time. Why? It is because the ban on smoking requires people to acquire a new custom (=“nonsmoking”). People need enough time to acquire this new custom. Enough time? But how long? Decades, a century or perhaps more as mentioned above. But, above all, it all depends on people.
If people can easily change the centuries-old custom (= “smoking”), people can also change the centuries-old custom of conflict resolution (=“violence”), in a relatively short period of time. Is it possible? Is it so easy? Ask those who are studying peace studies. They know the answer. Ask those who are working for peace. They know the answer. Lessons from peace studies can be applied to health studies. Lessons from peace work can be applied to health work.
After I posted my comment on “smoking” above, some people questioned me if “smoking” was a habit or a custom. Let me explain about it as follows:
A habit is a particular regular practice or a behavior pattern of an individual or of a small group of individuals. Therefore, the discussion about a habit focuses on the individual.
A custom, on the other hand, is a certain practice or a behavior pattern of a large number of people in a society. A custom contains at least the following five features: (1) A large number of people in their society practice it; (2) the practice is repeated regularly; daily, weekly, monthly, annually, every few years, etc., or it is practiced every time under a certain particular condition/situation; (3) the practice is continued for many years, decades or centuries; (4) the practice affects people’s lives, psychologically, physically, economically, politically, socially, religiously or culturally; and (5) as the result of the influence as such, this practice forms a certain aspect (or one of the aspects) of a culture of that society. Therefore, the discussion about a custom focuses on people collectively in their society because that particular practice or behavior is considered as a social phenomenon.
In general, “smoking” can be understood either as a habit or as a custom (or both). Whether “smoking” is a habit or a custom depends largely on how you understand “smoking”; an individual’s certain practice or a common behavior pattern of a large number of people, which you can observe in their society. An example: When you brush your teeth, if you move your toothbrush in a certain or particular way, it is your own habit. It is not done by a large number of people of your society. Therefore, it is not a custom of your society. But if a large number of people (of their society) do the same the way you brush your teeth, especially for a long period of time, for decades or centuries from generation to generation, this practice or behavior pattern cannot simply be understood as a certain individual’s habit. It is a social phenomenon. Moreover, if this practice produces a certain social effect, psychologically, physically, economically, politically, socially, religiously or culturally, and if it shapes a certain aspect of a culture of the society, it can be considered as a custom.
When I discussed “smoking” in my comment above, I treated it as a collective practice or a behavior pattern of a large number of people, which can be seen in many societies. If you move your toothbrush in a certain way — even if how strangely you move your toothbrush, it cannot be a social problem. It is just your own (strange) habit. But if “smoking” becomes a social problem, it is no longer appropriate to discuss it simply as an individual’s a certain habit. Furthermore, it can hardly be denied that “smoking” can be considered as a part of a culture of the contemporary society. If that is the case, it is highly likely that such practice (=”smoking”) includes the above mentioned five features to be considered as a custom.
Enough said as a comment of this kind. May peace and health be with you all.
Good arguments, thanks for the food-for-thought dear Satoshi.
My only question: I believe social habits are done in groups, rituals, including socialization, friendship, creating bonds and so forth. Cigarette smoking, however, is more like masturbation, if you allow me a crude example, but to the point. It is done in private, for private reasons, to fulfill some private urge (sex), independent of anybody else, culture, religion, beliefs, norms, mores, authority, and so on. Is masturbation a habit or a social custom? Because nobody knows who/when/where/how one does it. Not public.
I quit smoking because I wanted, for my own reasons, after some 30 years of addiction to it. Because it is not a habit, it is an addiction, a disease, that can, and is, cured by proper methods; difficult, but possible. Nicotine is a drug. Therefore, it is a medical problem, which may be seen as epidemic, or endemic, whatever. But if treated, it could be abolished.
My two cents, for what they are worth. I work with addicts to alcohol, drugs, gambling, food, etc., and the worst of all is the addiction to nicotine (not to smoking per se). Nicotine kills more than all others together, more than wars, as he points out.
Good discussion, that is why I posted this article, actually two, it is an issue close to my heart. And to peace because of the implications and consequences.
Thanks again, take care, I hope all is well in Sarajevo.
Antonio
1-1.Your question to me: “Cigarette smoking, however, is more like masturbation, if you allow me a crude example, but to the point. It is done in private, for private reasons, to fulfill some private urge (sex), independent of anybody else, culture, religion, beliefs, norms, mores, authority, and so on. Is masturbation a habit or a social custom?”
1-2. My answer to you: “A custom contains at least the following five features: (1) A large number of people in their society practice it; (2) the practice is repeated regularly; daily, weekly, monthly, annually, every few years, etc., or it is practiced every time under a certain particular condition/situation; (3) the practice is continued for many years, decades or centuries; (4) the practice affects people’s lives, psychologically, physically, economically, politically, socially, religiously or culturally; and (5) as the result of the influence as such, this practice forms a certain aspect (or one of the aspects) of a culture of that society.” So, do you think that masturbation contains the above “all” five features? (For instance, do you think that one’s masturbation affects people’s lives, psychologically, physically, economically, politically, socially, religiously or culturally? Do you think that, as the result of the influence (if any), masturbation forms a certain aspect of the culture of the society? You determine it according to the five criteria, Antonio. By the way, if you will seriously conduct a research of this kind, you may successfully be able to write an outstanding research paper on the relation between personal practice such as masturbation and the culture of the society.)
2-1. On the cigarette packages sold in some countries for instance, it is printed with a very large font, “Smoking kills you.” Nonetheless, people continue smoking. Who cares? This implies how stop-smoking is difficult for people once they are used to smoking.
2-2. “Alcoholic Anonymous” (AA)is well known. But “Nicotine Anonymous” (NA) is comparatively less well known. More power to NA! http://www.nicotine-anonymous.org/
Anyhow, thank you very much, Antonio, for your constant and amazing effort every week in preparing this intellectually and practically stimulating TMS website! All the best and have a good time for the rest of the day!
Thanks dear Satoshi. Obviously we would have to continue this interchange in person, not here; the more we say the more we have to say.
But thanks especially for providing the link to Nicotine Anonymous. This is definitely important, perhaps the best of all. You come definitely well prepared.
Have a good trip to Japan.
In peace,
Antonio