Friday, May 10, 2013

What is the Best Tobacco Policy?

Cigarettes have been in the news a lot these days, mostly as a result of the recent push to raise the smoking age from 18 to 21 in NYC as well as New York State. We have already noted (on Twenty-One Debunked) that we oppose such a plan, for many of the same reasons that we oppose the 21 drinking age.  However, the more basic question of what to do about tobacco in general is seldom discussed, and the debate over whether the minimum age should be 18 or 21 is really just window-dressing and a convenient distraction from the real issue.

It is a well-known fact that tobacco is the #1 preventable cause of death in the world, and that cigarettes are the only product that, when used as directed, will kill half of those who buy it.  The death toll is roughly six million people per year worldwide, with nearly half a million of them in the USA alone.  As historian Robert N. Proctor repeatedly notes in his book Golden Holocaust, the merchants of death known as tobacco companies have not only designed the world's deadliest product (and most addictive drug) but willfully lied about its dangers while making it far more dangerous (and addictive) than it has to be.  He actually makes an excellent case for banning cigarettes completely, and one cannot simply dismiss him as just another puritanical prohibitionist.  For example, he points out that not only are cigarettes the deadliest artifact of human civilization, they are defective by design (killing more people than they need to), they are not particularly useful, and they are not environmentally sustainable.  And unlike alcohol or cannabis, cigarettes are not a recreational drug since the vast majority of smokers want to quit.  Clearly, we can agree that if alcohol, tobacco, and cannabis were all currently legal and we had to pick one of them to ban, tobacco would have to be it since it is the least useful and most harmful of the three.

While the TSAP believes that a (relatively) tobacco-free world would most likely be better overall than the one we live in now, we do not believe that a complete ban on the sale of cigarettes or other tobacco products is the best way to achieve such a goal, particularly in a country like the USA.  Given our nation's bitter experience with alcohol Prohibition and the War on (some) Drugs, there would be many foreseeable unintended consequences (black markets, crime, etc.) with such an approach, albeit not quite as severe.  Virtually all serious endgame proposals for tobacco involve a gradual phase-out of some sort, though there is some disagreement on the best way to do it and how to define "victory."

As of 2013, the endgame strategy that the TSAP currently supports is to let tobacco phase itself out by gradually reducing the nicotine content of cigarettes to a (relatively) non-addictive level.  Since 2009, the FDA now has the authority to set a legal limit on the nicotine content of tobacco products, as long as the limit is not zero.  Much research indicates that there is a threshold level of nicotine required to create and sustain addiction, and if all cigarettes were to fall below this threshold, smoking rates would plummet precipitously.  In fact, one tobacco executive was quoted as saying, "‘If our product was not addictive we would not sell a cigarette next week."  This idea was originally proposed by Henningfield and Benowitz in 1994, and has been endorsed by the American Medical Association and several other experts including Proctor himself.  Malcolm Gladwell also discussed it in his aptly-titled 2000 book The Tipping Point.   Thus, the TSAP recommends reducing the maximum nicotine content (not delivery) of cigarettes from the current level of 1-2% to less than 0.1% within 5 years, and doing the same for quasi-cigarettes (i.e. little cigars) and roll-your-own tobacco.  That alone would reduce smoking prevalence by as much as 80% within a fairly short timeframe, with further reductions possible in the more distant future.

The TSAP also recommends the following measures be taken as well:
  • Ban the use of additives in cigarettes, especially those that are harmful or increase the addictiveness of tobacco.
  • Ban the use of any radioactive fertilizers or harmful pesticides for growing tobacco.
  • Improve the quality control standards for tobacco products to be at least as high as for food.
  • End all government subsidies for tobacco farming and production.
  • Divest completely from Big Tobacco at all levels of government.
  • Vigorously enforce the current age limit of 18 for tobacco sales to achieve 100% retailer compliance. 
  • Continue to allow widespread availability of reduced-harm tobacco and nicotine products (i.e. snus, electronic cigarettes, etc.) so that smokers can easily switch to less dangerous alternatives.
  • Improve education and smoking cessation programs, funded by tobacco tax revenues.
  • Give out free nicotine patches, gum, etc. to any smokers who want to quit.  NYC already does this. 
At the same time, the TSAP most certainly does NOT support outdoor smoking bans or any other policy that treats smokers like criminals or second-class citizens.  Smokers are NOT the villains here, as that dubious honor belongs to the merchants of death known as tobacco companies.  In fact, we have repeatedly pointed out that, far from being a drain on society, smokers actually save society money in the long run since they more than pay their way as far as taxes go.  Cigarette taxes, especially in NYC where they are extremely high, have basically become a "reverse Robin Hood" way to rob from the poor and give to the rich, since smoking has increasingly become a poor man's vice.  And the wide disparity in cigarette taxes across states has led to a serious black market for untaxed/low-tax/counterfeit/stolen cigarettes, with the main beneficiaries being organized crime syndicates and even terrorists.  Thus, we recommend that the handful of states with cigarette taxes higher than $2.00/pack reduce their tax to $2.00/pack or lower, and the states with taxes of less than $1.00/pack raise it to $1.00-$2.00/pack.  NYC should cut its tax in half.  At the federal level, we recommend no further tax hikes, but a national price floor of $5.00/pack including tax to discourage smuggling.

So that is basically the TSAP tobacco policy as of 2013.  Except for our new endgame strategy, our views on tobacco-related issues have really not changed significantly since our founding in 2009.

The tobacco industry has dug its own grave.  Time to push them in there.

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