Monday, August 3, 2009

As Long As We're Talking About Health Care ...

With health care reform the hot topic of discussion these days — that is, when the president isn't sitting down for a beer and a "teachable moment" on race relations — it's a good idea to revisit something that has caused a great deal of preventable suffering and death in America and the world — tobacco.

Tony Newman of the Drug Policy Alliance Network did precisely that last week in a commentary written for

"Cigarettes kill; 400,000 people die prematurely every year from smoking," Newman writes. "When we analyze the harm from drugs, there is no doubt that cigarettes are the worst."

A lot of things have changed over the years — in particular, attitudes about smoking.

I started smoking the way most people do, as a teenager. I remember once, when we were visiting my grandmother, I stepped outside to sneak a smoke. I didn't think anyone saw me or knew what I was up to, but after I returned to the house, my grandmother came up to me and let me know, without saying so, that she knew what I had done. "Most men smoke," she said to me.

That was probably true of the men of her generation. But, as we have learned more about the harmful effects of smoking, attitudes have changed. In 1965, the year after the surgeon general first connected the dots between disease and tobacco consumption, the smoking rate in the United States exceeded 40%. By 2006, it had been cut in half.

I quit smoking more than two years ago. It wasn't easy. It was pretty damn hard, actually. And, as I have said before, it is still difficult for me. I expect it to remain difficult for a long time to come. I've heard stories about people who still experience cravings 20 years after their last cigarette.

Knowing what I know now, I'm glad I gave up smoking, although I still can't really bring myself to refer to myself as a "former smoker." I refer to myself as a "recovering smoker" because I know that, like a recovering alcoholic, I'm just one slip away from being back where I started.

I have told my friends who still smoke — and, in part because of what I have accomplished, there are fewer of them today than there were two years ago — that I have definite opinions about tobacco use, but I'm not the kind of person who will crusade against something I once did. My best friend since high school recently gave up smoking on doctor's orders — he had suffered a heart attack. His daughter (my goddaughter) also gave up smoking.

I'm glad they did, but I didn't tell either one of them to quit. I believe adults should be allowed to make their own decisions.

Tobacco — especially in the nicotine–manipulated form that was peddled by the tobacco companies for years — is extremely hazardous, but it is legal. I was astonished to read in Newman's commentary that many people think it should be illegal.
"The Drug Policy Alliance sponsored a Zogby Poll in 2006, and we were shocked to find that 45 percent of those polled supported making cigarettes illegal within the next 10 years. Among 18– to 29–year–olds, it's more than 50 percent."

Tony Newman

Newman's response to that finding made a lot of sense to me.

"[W]ith all of the good intentions in the world, outlawing cigarettes would be just as disastrous as the prohibition on other drugs," he writes. "After all, people would still smoke, just as they still use other drugs that are prohibited, from marijuana to cocaine. But now, in addition to the harm of smoking, we would find a whole range of 'collateral consequences' that come along with prohibition. A huge number of people who smoke would continue to do so, but now they would be considered criminals."

I am glad, as I have written, that Congress voted to give the FDA authority over the tobacco industry. But I don't think the answer is to create a new group of criminals, as Newman points out.

I'm not a lawyer so those who are lawyers might disagree with this. But it seems to me that — with the exception of laws that prohibit violent behavior — laws don't exist to define and enforce morality. And it was on the basis of morality that alcohol was outlawed in this country during the era of Prohibition. The Eighteenth Amendment was passed under considerable pressure from the temperance movement, and it took another amendment to the Constitution to repeal it.

In contrast, the prohibition of marijuana has been in effect, essentially, for more than 70 years. Yesterday, as a matter of fact, was the anniversary of the passage of the 1937 Marihuana Tax Act, which began the process that made marijuana and its byproducts illegal. No constitutional amendment was passed making it illegal. And morality — or the alleged consequences to public health — had nothing to do with it. It was, as Pete Guthier writes, the result of racism, fear, corporate protectionism, "ignorant, incompetent and/or corrupt legislators" and "personal career advancement and greed."

Public health and morality were never factors.

Actually, Guthier wrote a piece yesterday that pretty convincingly states that "harmlessness" is irrelevant.

Nothing, he writes, is completely harmless, even those things that seem harmless.

"[Y]ou may think that water is harmless, and it is, if you're drinking a glass," he writes. "However, it is clearly possible to fatally overdose on water, and floods kill people all the time."

Since my mother died in a flash flood, this observation, as you might guess, holds particular significance for me.

To further establish his point, Guthier provides a whole list of things that are legal but potentially harmful:
"Easy ones ...
  • Tobacco

  • Alcohol
... but there's lots more:
  • Eggs

  • Milk

  • Construction Work

  • Taking a vacation

  • Bridges

  • Stairs
Contractor: So, Mr. and Mrs. Johnson, I see here that you're asking us to put stairs in between the first and second floor in your new house. Well, we can do that, of course, but I do feel obligated to warn you that stairs aren't harmless.
  • Buckets

  • Electric Blankets

  • Fishing

  • Crossing the Street

  • A cookie."

In his piece, Guthier provides links to articles showing how all these things (with the exception of tobacco and alcohol, which need no elaboration) have the potential to be harmful.

Then he concludes with this: "When prohibitionists play the 'harmless' game, they're trying to distract people from the real argument — the harmfulness of prohibition."

And marijuana prohibition has already led to plenty of harm — a thriving black market, criminal records for otherwise law–abiding citizens, the loss of billions of dollars in annual tax revenue.

Actually, what we need to do is replace current drug policy with the common–sense approach that has been working with tobacco.

"[O]ur public health campaign around cigarettes has been a model of success compared with our results with other prohibited drugs," Newman writes. "Although we should celebrate our success and continue to encourage people to cut back or give up smoking, let's not get carried away and think that prohibition would eliminate smoking.

"We need to realize that drugs, from cigarettes to marijuana to alcohol, will always be consumed, whether they are legal or illegal. Although drugs have health consequences and dangers, making them illegal — and keeping them illegal — will only bring additional death and suffering."


No comments: