Columns, Opinions

Shanmugam ’23: Tobacco use should be illegal

By
Staff Columnist
Wednesday, November 20, 2019

Google a list of the world’s most addictive substances, and some of what you’ll find is to be expected: illegal Schedule 1 drugs like cocaine, methamphetamines and heroin.

One item on this lamentable list, though, seems out of place: good, old-fashioned nicotine. Located in virtually all tobacco products, the drug remains perfectly legal in America — unlike its equally habit-forming counterparts. Nicotine is the foundation of a $100 billion industry, profitable only because it exploits bodies, brains, pocketbooks and healthcare systems.

The government has a responsibility to carefully limit our rights when public interest is at stake, and in this case it is: one in five American preventable deaths are a result of smoking. These lives — along with the billions of dollars that smoking costs our healthcare system each year — can be saved if lawmakers take action. Because of the deadly impact that tobacco use has on lives and the burden it imposes on all of us via the healthcare system, the federal government should impose an absolute ban on tobacco.

Should government be in the business of protecting individuals from their own behavior? That question is difficult to answer when it comes to dangerous substances, and legal experts don’t have a clear answer.

What is clear, however, is that the government has an obligation to step in when those behaviors negatively impact others. The most obvious of these negative externalities is secondhand smoke, the carcinogenic cocktail of over 7,000 chemicals that floats off the burning end of a cigarette. This inadvertently subjects even non-smokers to the health risks that come from these chemicals. Despite the growing prevalence of smoke-free zones, secondhand smoke exposure continues to exact a grave toll on lives and the economy, running up $5 billion in medical costs, $4.6 billion dollars in lost wages and 33,950 heart disease-related deaths every year.

Worse still: those statistics only count adults. When Americans smoke cigarettes, they are endangering not only themselves, but also their siblings, children and grandchildren. Children whose parents and siblings smoke are exposed to the medical consequences of secondary exposure; but even worse, they are also more likely to pick up smoking themselves. When a behavior comes with about a $10 billion price tag — and when it is actively killing people ­— it is impermissible.

Yet tobacco use inflicts even more severe and wide-reaching damage. When tobacco users need to be treated for a host of resultant diseases — Chronic Obstructive Pulmonary Disease, lung cancer, heart disease and more — they aren’t the only ones paying the $170 billion yearly expense of smoking. Healthcare costs in America are shared among taxpayers, in part via programs like Medicare, Medicaid and the Veterans Health Administration, which offer critical support to those in need. But because smokers tend to be less wealthy than non-smokers, a worrying trend emerges: 60 percent of the $170 billion dollar yearly cost of smoking is paid via these programs, which are funded mostly through taxpayer dollars. The link is indirect but obvious: our tax dollars are handing big tobacco a light.

Even in the private insurance markets, non-smokers end up footing the bill. Insurers are permitted under current health care law to demand up to 50 percent higher premiums from smokers — on paper, that is supposed to prevent non-smokers from subsidizing self-destructive behavior. In practice, though, there are two caveats. First, because it is impractical to test all policyholders for nicotine use, insurance companies have to depend on the honor system. Consequently, some tobacco users are thus paying premiums equivalent to those of non-smokers, and passing on costs to the rest of us when it comes time for health insurers to pay up. Worse still, the high premiums demanded of smokers could cause many of them to forgo insurance altogether. It might seem like a good thing for the rest of us when fewer smokers buy insurance— after all, it eliminates the risk that insurance companies have to account for, and this brings down premiums — but that raises a new set of problems. When hospitals and insurance companies have to unexpectedly foot the bill for uninsured smokers in the event of acute, life threatening illness — such as stroke and heart attack —  those firms maintain profit margins by raising costs for the rest of us.

If all of this makes it tempting to demonize smokers, consider that quitting is a daunting challenge, pitting one’s mind and body against the thrall of addiction. Instead, the real blame lies on the companies with business models that prey on health to make a profit. Addiction distorts one’s ability to evaluate goods relative to their prices. Arguments that free market conventions and excise taxes can deter people from buying cigarettes ignore that fact. Only an absolute ban on tobacco can fix this market failure.

In the absence of prohibition, Big Tobacco has an incentive to get people hooked. The industry’s $9.5 billion marketing budget often targets people in insidious ways. About $7 billion of this goes to discounts that temporarily reduce the prices consumers pay — making it easy for consumers to say yes to cigarettes, until they can no longer say no. Even more problematically, tobacco marketing targets specific demographics, like young people and African Americans. Stanford Medical School researchers made a chilling finding in their analysis of cigarette sales in California neighborhoods among a large proportions of young and nonwhite residents. A 10 percent increase in the proportion of African American students enrolled in a school district correlated with a 12 cent decrease in the cost of a pack of Newport cigarettes sold in that district. A 10 percent increase in the number of adolescent residents in a school district correlated with an 11 percent increase in the frequency with which menthol cigarettes were advertised. Both these findings show that when more African American students were in a given school district, tobacco companies lowered prices and pushed flavored cigarettes (more popular among young people) in these areas. These practices are clearly predatory. Congress should take the hint.

Arguing for the end of cigarette sales, Robert Proctor, professor of History of Science at Stanford University, calls the cigarette “the deadliest artifact in the history of human civilization.”

Tobacco is unequivocally destructive to society, to the economy and to the human body. It provides no benefit to its users or those around them. Faced with an industry that profits off the taxpayer’s dollar, that feeds on the weakest members of society and that sells a product which kills millions of Americans, we need to quit smoking for good.

Arjun Shanmugam ’23 can be reached at arjun_shanmugam@brown.edu. Please send responses to this opinion to letters@browndailyherald.com and op-eds to opinions@browndailyherald.com.

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