Reason Magazine - Topics > Tobacco

When the Government Does It, It's Not Fraud

jsullum@reason.com (Jacob Sullum) — Thu, 17 Jul 2008 18:39:00 EDT

The Federal Trade Commission has proposed (PDF) withdrawing its blessing from the tar and nicotine yields included in cigarette advertisements because these machine-generated numbers are not good indicators of what smokers actually absorb:

The current yields tend to be relatively poor predictors of tar and nicotine exposure. This is primarily due to smoker compensation, i.e., the tendency of smokers of lower-rated cigarettes to take bigger, deeper, or more frequent puffs, or to otherwise alter their smoking behavior [e.g., by subconsciously covering ventilation holes] in order to obtain the dosage of nicotine they need.

The differences between the way a machine smokes in a laboratory and the way people smoke in real life have been acknowledged since the FTC first approved the "FTC method" for measuring tar and nicotine yields in 1966. But the issue has received increasing attention during the last couple of decades. After studies confirmed that the official yields are unreliable indicators of individual exposure, anti-smoking activists and trial lawyers began to argue that the numbers are inherently fraudulent, part of a scam in which tobacco companies trick consumers into believing that "light" cigarettes are less dangerous than full-strength brands. Since the research indicates that "light" cigarette smokers only partially compensate for lower yields, they should still take in less tar than they otherwise would, but any health advantage is smaller than initially hoped. A better approach would have been to increase the nicotine-to-tar ratio, rather than reducing both yields.

In response to these concerns, the FTC now wants to "withdraw its guidance...indicating that factual statements of tar and nicotine yields based on the Cambridge Filter Method generally will not violate the FTC Act." Under its proposed rule, cigarette makers could not assert or imply FTC approval of the yields, and they probably would stop using them entirely, fearing that the commission would deem them misleading. This shift in policy is overdue, but the FTC is less than forthright about its own complicity in making tar and nicotine yields ubiquitous in cigarette ads. The commission says its "1966 guidance does not require companies to state the tar and nicotine yields of their cigarettes in their advertisements or on product labels." But as epidemiologist Ronald Davis and his colleagues noted in a 1990 American Journal of Public Health article (PDF), the story is a little more complicated:

Since 1971, all major cigarette manufacturers have voluntarily disclosed the tar and nicotine yields of cigarette brands in advertisements. The cigarette industry agreed to "voluntary" disclosure after the US Federal Trade Commission (FTC) had proposed a regulation that would have required such disclosure. This agreement does not apply to cigarette packages.

So if advertising tar and nicotine yields amounts to fraud, it's a fraud that was not only endorsed but in effect required by the federal government. That did not stop the federal government from suing the tobacco companies over their "light" cigarette marketing. Nor did concerns about compensatory smoker behavior stop activists and legislators from trying to authorize the Food and Drug Administration to order reductions in nicotine content, a policy that would make cigarettes more hazardous by increasing the amount of toxins and carcinogens absorbed for a given dose of nicotine.

San Francisco May Damn-Near Outlaw Smoking

rbalko@reason.com (Radley Balko) — Wed, 16 Jul 2008 15:51:00 EDT

Two new proposals on the table in San Francisco:

Smokers would find it harder to buy their cigarettes and light up in public under two proposals under consideration by the San Francisco Board of Supervisors.
Mayor Gavin Newsom has proposed prohibiting tobacco sales in pharmacies, including Walgreens and Rite Aid. The city's public health chief said the proposal is modeled after rules in eight provinces in Canada but has not been tried anywhere in the United States.
Supervisor Chris Daly has proposed legislation that would vastly limit areas where people can smoke.
Gone would be smoking in all businesses and bars, which now make an exception for owner-operated ones.
Gone too would be lighting up in taxicabs and rental cars, city-owned vehicles, farmers' markets, common areas of apartment buildings, tourist hotels, tobacco shops, charity bingo games, unenclosed dining areas, waiting areas such as lines at an ATM or movie theater, and anywhere within 20 feet of entrances to private, nonresidential buildings.
Mitch Katz, director of the Department of Public Health, said he strongly supports both measures - even if they are angering business owners who say it's one more example of San Francisco City Hall overstepping its bounds.
"Tobacco remains the No. 1 cause of preventable death in the U.S. - period," he said. "It's government's responsibility to protect people from obvious risks."

Why the Cavemen Went Extinct (Winston Tastes Good Like a Cigarette Should Edition)

gillespie@reason.com (Nick Gillespie) — Sat, 05 Jul 2008 19:36:00 EDT

This isn't new—indeed it's 40-plus years old—but this commercial is still incredibly funny, strange, and totally fucking bizarre. No wonder the Soviets lost the Cold War!

Watch as Barney Rubble and Fred Flintstone goldbrick and debate the merits of Winston cigarettes in a kinder, gentler America:

Dickie Scruggs Tries the Wrong Kind of Bribery

jsullum@reason.com (Jacob Sullum) — Mon, 30 Jun 2008 12:00:00 EDT

Richard Scruggs, the Mississippi plaintiffs' attorney who spearheaded the first state lawsuit seeking compensation for tobacco-related medical expenses from cigarette manufacturers, was sentenced to five years in prison on Friday. After Scruggs filed a lawsuit on behalf of Mississippi, many other states joined the shakedown, ultimately resulting in a settlement that brought more than $200 billion to state treasuries and billions more to lawyers like Scruggs, all at the expense of smokers forced to pay higher prices in a market rigged by a government-endorsed conspiracy in restraint of trade. But Scruggs is not going to prison for any of that. Bribing state governments with other people's money in exchange for huge kickbacks is perfectly legal. But bribing a state judge overseeing a dispute regarding your legal fees is not.

[Thanks to Bill Cook for the link.]

I Swear, Officer, It's Only Marijuana!

jsullum@reason.com (Jacob Sullum) — Wed, 25 Jun 2008 14:38:00 EDT

A Dutch ban on smoking in businesses open to the public takes effect on July 1, and owners of marijuana-selling "coffee shops" are worried. They're not worried because the ban will prevent their customers from smoking pot. Although the combustion products of any dried weed include toxins and carcinogens, cannabis is exempt from the law, which is ostensibly aimed at protecting employees. It's hard to see what purpose this disparate treatment serves, aside from horrifying American conservatives with the prospect of a topsy-turvy world in which you can smoke pot but not tobacco. But since European pot smokers often mix tobacco into their joints, The Independent reports, coffee shop operators are afraid the smoking ban will cut into their business:

"The new rule is nonsense," said Willem Panders, of the Dutch tobacco traders' union. "It will be almost impossible to enforce because how are you going to check if someone is smoking cannabis mixed with tobacco, or pure cannabis?"...
Marc Jacobsen, of BCD, a national association of coffee-shop owners which has been urging the government to give them special status, told the online version of Der Spiegel: "In a cafe you come to drink something. In a restaurant you come to eat. But when you come to a coffee shop you come to smoke, so smoking has to be allowed in a coffee shop."...
Sandy Lambrecht, the manager of the Bulldog coffee shop on the Leidseplein in the heart of Amsterdam, said: "The new rules are absurd. You come to a coffee shop to smoke, after all—it's ridiculous that we have to comply. The new rules are meant to protect employees like me, but the point is that we chose to work here."
Paul Wilhelm, the owner of De Tweede Kamer, one of Amsterdam's most famous coffee shops, founded in 1985, argued: "If the boys are old enough to be sent to Afghanistan, then you can't tell me that people want to protect them from smoke in the workplace. They're old enough to decide on their own. They can vote, they can go to war—but now they won't even be allowed to make this decision?"

These are not arguments for exempting coffee shops from the smoking ban; these are arguments for repealing the smoking ban.

[via the Drug War Chronicle]

I Didn't Ask for Help

mriggs@reason.com (Mike Riggs) — Mon, 16 Jun 2008 11:47:00 EDT

Smoker's Quitline is on the verge of declaring "Mission Accomplished," since New York's "highest-in-the-nation cigarette tax" went into effect two weeks ago.

The Quitline provides all kinds of "help" for people who "want" to quit smoking, and requests for their services have increased by the thousands since NY levied the tax. In New York, apparently, not being able to afford your habit equates to not wanting to do it anymore:

"Not everyone that tries, quits," Daines said. "We estimate about 140,000 New Yorkers will successfully quit smoking. We may have more than a million try to cut down or stop, but this is how you get people to try: give them multiple chances and multiple reasons to stop." [emphasis added.]

Kudos to Associated Press writer Valerie Bauman for getting Audrey Silk, head of NYC Citizens Lobbying Against Smoker Harassment, on the record stating her logical opposition to the $1.50-per-pack increase:

"No matter the goal, it's disgusting that any group would actually boast that coercive government — this time through the hammer of taxation — to beat a class of society enjoying a legal product into submission is 'successful'," Silk said.

Past reason contributor Ed Carson with a 1995 rebuttal to sin taxes. And of course, no smoking-related post would be complete without a reference to Senior Editor Jacob Sullum's book, For Your Own Good: The Anti-Smoking Crusade and the Tyranny of Public Health.

Cigarette Flavoratism

jsullum@reason.com (Jacob Sullum) — Wed, 11 Jun 2008 13:00:00 EDT

For years I've argued that a bill authorizing the Food and Drug Administration (FDA) to regulate tobacco products is bad for consumers. I've said the Family Smoking Prevention and Tobacco Control Act, which Congress is once again considering, would stifle competition, raise prices, reduce variety, block the flow of potentially lifesaving information, and impede the introduction and promotion of safer tobacco products.

Such arguments have attracted remarkably little attention, given that consumer protection is the main rationale for FDA regulation. Now I realize my mistake: I should have said the bill was racist.

In my defense, I did not realize until recently that the bill was racist. Then again, neither did the people making that argument.

Take Joseph Califano, who has been a vociferous opponent of smoking since he served as Jimmy Carter's secretary of health, education and welfare. Despite his longstanding interest in the issue, it seems Califano never got around to reading the tobacco bill, which was first introduced in 2004, or at least did not notice a provision he now deems outrageously discriminatory.

Califano told The New York Times his eyes were opened by Louis Sullivan, secretary of health and human services under George H.W. Bush, who called him to complain that the bill bans all cigarette flavors except menthol. It's not clear why Sullivan only recently got riled up about this provision, which anti-smoking activists have been murmuring about for years.

It may have had something to do with a May 13 New York Times story headlined "Cigarette Bill Treats Menthol With Leniency," which reported that "some public health experts are questioning why menthol, the most widely used cigarette flavoring and the most popular cigarette choice of African-American smokers, is receiving special protection as Congress tries to regulate tobacco for the first time." The front-page article quoted William S. Robinson, head of the National African American Tobacco Prevention Network, who explained that his organization and other anti-smoking groups had gone along with the menthol exemption because it was necessary to placate Philip Morris, the only major cigarette maker supporting the bill.

Philip Morris sells a lot of menthol cigarettes, but the flavors forbidden by the bill are offered only by its competitors. The bill's flavoritism is of a piece with its general tendency to help the industry leader maintain its market dominance.

But Robinson was willing to live with the Philip Morris-favoring menthol compromise until two weeks after the Times story ran, when he announced that his group had withdrawn its support for the bill because "our constituents across the country are just livid." In a June 5 op-ed piece published by The Atlanta Journal-Constitution, Califano, Sullivan and Robinson explained the source of that anger.

"This loophole especially undermines the health of African-Americans," they said, since 75 percent of black smokers prefer menthol brands, compared to 32 percent of white smokers. "The bill blatantly discriminates against African-Americans."

In a June 4 letter that was also signed by five other former health secretaries and one former surgeon general, Califano et al. urged Congress to ban menthol cigarettes. Since the rationale for banning flavored cigarettes is that kids like them, the letter said, the menthol exception "sends a message that African American youngsters are valued less than white youngsters."

There are other ways to look at it. Given that white menthol smokers outnumber black menthol smokers by three to one, maybe this isn't such a black thing after all. Alternatively, since the bill allows blacks to smoke the cigarettes they prefer, a freedom it does not allow whites who like clove cigarettes or Camel Cremas, you could argue that it discriminates in favor of blacks.

People who want to ban flavored cigarettes, of course, believe that letting smokers have what they want is a hostile act. But if so, the fact that the bill allows tobacco companies to continue selling the non-mentholated cigarettes overwhelmingly preferred by whites suggests that it blatantly discriminates against European Americans.

Pot and Cigarettes Are Now Equally Popular (Among Teenagers)

jsullum@reason.com (Jacob Sullum) — Wed, 04 Jun 2008 18:31:00 EDT

The latest data from the CDC's Youth Risk Behavior Surveillance System indicate that the percentage of teenagers who smoke marijuana is essentially the same as the percentage who smoke cigarettes. In the 2007 survey, 19.7 percent percent of high school students reported smoking marijuana at least once in the previous month, while 20 percent said they'd smoked at least one cigarette. The Marijuana Policy Project notes that tobacco smoking is declining faster among teenagers than marijuana smoking:

The cigarette use figure represents a sharp drop from the 2005 survey, when it was 23 percent. Marijuana use, at 20.2 percent in 2005, showed a much smaller decline....
Another report released this week, the Fiscal Year 2007 Annual Synar Report on tobacco sales to youth, showed the 10th straight annual decline in the rate of illegal tobacco sales to minors. In 1997, 40.1 percent of retailers violated laws against tobacco sales to minors. In 2007 the rate had dropped to just 10.5 percent, the lowest ever.
"Efforts to curb cigarette sales to teens have been wildly successful, and it's past time we applied those lessons to marijuana," said Aaron Houston, director of government relations for the Marijuana Policy Project in Washington, D.C. "Tobacco retailers can be fined or put out of business if they sell to kids, but prohibition guarantees that we have zero control over marijuana dealers. Foolish policies have guaranteed that the marijuana industry is completely unregulated."

This is true enough, and I've often made a similar argument. But honest opponents of prohibition have to admit that leakage from the adult market for any legal intoxicant is inevitable. Note that the rate for past-month alcohol consumption in the same survey was 45 percent, making it more than twice as common among teenagers as pot smoking. (That's up from 43 percent in 2005 but the same as in 2003.) To project the impact that repealing prohibition would have on underage pot smoking, you need to weigh the effect of regulation against the effect of easier, safer, and cheaper availability to adults.

Then there's the question of how much weight should be attached to the risk of increased consumption by minors. To me, underage cigarette smoking is more troubling (legal issues aside) than underage drinking or pot smoking, because it is much more likely to result in a long-term habit that has serious health consequences. Others, focusing on the immediate psychoactive effects and the associated risk of reckless behavior or academic disruption, may worry more about alcohol and pot.

I am not conceding, by the way, that a utilitarian analysis like this one is the right way to find the ideal drug policy. If adults have a fundamental right to control their bodies and the chemicals that go into them, the possibility that some may deliberately or accidentally share those chemicals with minors does not justify violating that right. But most Americans do not accept that premise, so predictions about how repealing prohibition would affect The Children are unavoidable.

Pouch vs. Patch

jsullum@reason.com (Jacob Sullum) — Thu, 29 May 2008 17:30:00 EDT

Judging from a new study reported in Harm Reduction Journal, switching to smokeless tobacco is one of the most effective ways to stop smoking. Based on data from the 2000 National Health Interview Survey, University of Louisville researcher Brad Rodu and University of Alberta researcher Carl Phillips estimate that 359,000 men had switched to smokeless tobacco in their most recent quit attempt, of whom 261,000 were former smokers at the time of the survey. That represents a success rate of 73 percent, which looks pretty good compared to the rates for the other methods:

Smokeless Tobacco: 73%

Stop Smoking Clinic/Program: 50%

One-on-One Counseling: 43%

Nicotine Patch: 35%

Nicotine Gum: 34%

Bupropion (a.k.a. Zyban/Wellbutrin): 29%

Nicotine Inhaler: 28%

Nicotine Nasal Spray: 0%

Notably, the vast majority of successful quitters used none of the above methods. Of smokers who said they "stopped all at once (cold turkey)," a group that consisted mainly of smokers who quit without drugs or professional assistance but also included smokers who used one or more of the listed methods, 64 percent were successful.

The differences in success rates may be partly due to self-selection bias. Smokers who quit abruptly on their own, without nicotine replacement or pills, may be less attached to the habit or more strong-willed than smokers who use other methods. Smokers who attend clinics or counseling sessions may be more highly motivated and therefore more likely to succeed, regardless of how effective the professional help is. Likewise, perhaps quitters who switch to smokeless tobacco are different from quitters who try patches, gum, or pills in a way that makes them more likely to succeed. It seems plausible, however, that smokeless tobacco is a more satisfying/acceptable cigarette substitute than patches or gum, largely because the nicotine dose it delivers is closer to what smokers are used to getting. The fact that it is viewed as a long-term replacement, as opposed to a stopgap measure or cure, may also be a factor.

As Rodu and Phillips note, switching to smokeless tobacco (especially low-nitrosamine snus) eliminates almost all of the health risks associated with cigarette smoking. Judging from this study (which, it should be noted, considered only each smoker's most recent quit attempt), it is the most effective method of quitting. Yet it was much less popular than nicotine patches, which were used by nearly 3 million of the men who tried to quit (eight times the number who switched to smokeless tobacco). It was also less popular than nicotine gum or the antidepressant bupropion, each of which was used in about 1 million quit attempts.

Switching to smokeless tobacco presumably would become a more popular method of quitting if more smokers realized that snus is much less hazardous than cigarettes. Surveys indicate that the vast majority still think the two forms of tobacco are equally dangerous. This is not very surprising, since public health officials and anti-smoking activists have not only resisted promoting snus as a harm-reducing alternative to cigarettes but have misrepresented the evidence about smokeless tobacco's health advantages.

The full text of the study is here (PDF).

The Times Discovers the Tobacco Bill's Flavoritism

jsullum@reason.com (Jacob Sullum) — Tue, 13 May 2008 18:12:00 EDT

The New York Times notices that the bill authorizing the Food and Drug Administration to regulate tobacco products bans every cigarette flavor but menthol. Not coincidentally, Philip Morris, the only cigarette manufacturer that supports the bill, sells mentholated brands, while those other flavors are used by its competitors. But instead of wondering whether a bill that seems designed to reinforce the advantages of the industry leader is good for consumers, the Times suggests menthol should be banned too. It offers three reasons:

1) Menthol cigarettes are "the most popular cigarette choice of African-American smokers," who account for a disproportionate share of the market for brands such as Newport and Kool. The Times never explains why this is troubling, but the concern is of a piece with the anti-smoking refrain that it's especially reprehensible for tobacco companies to "target" blacks because they, like women and children, are a "vulnerable group."

2) "Menthol smokers may be exposed to higher levels of dangerous compounds than nonmenthol smokers." If so, the greater hazard could be due to chemicals produced by burning menthol or to menthol's cooling, anesthetic effect, which might encourage smokers to take bigger or deeper puffs or hold them longer. But there's no firm evidence that mentholated brands are in fact more dangerous. The Times cites a CDC scientist who refers to "multiple lines of evidence, generally consistent, suggesting that there's reason for concern," while conceding "there are few definitive answers about the health impact of menthol cigarettes." A 2002 review by the CDC and the National Cancer Institute, the Times reports, "said the research up to that point had been inconclusive," and "in five large studies of menthol to date, only one has found higher rates of cancer among menthol smokers than nonmenthol smokers, and only in men."

3) Menthol "may make it harder for the addicted to kick the smoking habit." How so? "One theory suggests that menthol in cigarettes, by providing an additional pleasurable sensory cue to smokers, reinforces addiction." This is just another way of saying that people who smoke menthol cigarettes like the way they smell and taste.

As I noted a few years ago, when an earlier version of this tobacco bill was introduced, anti-smoking activists consider good taste inherently objectionable, ostensibly because it appeals to minors. Former Sen. Mike DeWine (R-Ohio), a co-sponsor of that bill, tells the Times, "We were able to eliminate the use of flavored cigarettes, strawberry, mocha, and all this stuff that is clearly targeted at young kids...to start them smoking tobacco." As usual, this argument goes unchallenged, but it is patently absurd to claim that luring underage smokers is the only possible reason for adding flavor to tobacco products. People over the age of 18 have been known to smoke clove cigarettes, vanilla-flavored cigars, and cherry-infused pipe tobacco. Instead of pretending that it's all about the kids, the advocates of FDA regulation should admit that they want to make the smoking experience as boring and unpleasant as possible, the better to deter everyone, whether 16 or 60, from consuming tobacco products.

My most recent column on the tobacco bill is here.

Inhale Your Vapor If You've Got It

jsullum@reason.com (Jacob Sullum) — Wed, 07 May 2008 12:47:00 EDT

The Colorado Springs Gazette reports that at least two companies are selling electronic nicotine inhalers shaped like cigars, cigarettes, and pipes as tobacco substitutes. The manufacturers aim to avoid FDA regulation by marketing the devices not as a quitting aids (or, as the FDA would see it, treatments for the disease of nicotine addiction) or as safer (and therefore disease-ameliorating) alternatives to cigarettes but as a way to get your nicotine fix when you're not allowed to smoke. The article quotes one anti-smoking activist, Bill Godshall of Smokefree Pennsylvania, who welcomes the inhalers, and another, Alan Blum, director of the University of Alabama Center for the Study of Tobacco and Society, who sounds ambivalent. But both are mavericks within the anti-smoking movement: Godshall also favors smokeless tobacco as a harm-reducing alternative to cigarettes, and Blum at one point was sympathetic to that idea.

I predict most anti-smoking activists will be outraged by these products. First, they will argue (as they do with respect to smokeless tobacco) that the inhalers give smokers a way to endure smoke-free environments more comfortably and therefore blunt the effectiveness of smoking bans as a way of encouraging smokers to quit. That's probably true, but from a "public health" point of view you'd have to weigh the people who continue to smoke because of these products who otherwise would have quit against the smokers who switch mostly or entirely to the inhalers, thereby dramatically reducing their intake of toxins and carcinogens. Second, many, if not most, anti-smoking activists are uncomfortable with the idea of continuing to use nicotine indefinitely, regardless of the health consequences, because they view drug addiction as inherently bad. In their view, complete abstinence is the only acceptable alternative. Again, from a "public health" perspective, which seeks to minimize morbidity and mortality, this stance is highly questionable, since it could well result in more disease, not less.

From a libertarian perspective, of course, the issue is easy: Let manufacturers sell whatever tobacco or nicotine products they choose, as long as they're honest, and let consumers make their own tradeoffs between risk and pleasure, regardless of the impact on collective measures of health. That's not likely to be the way this shakes out, of course. I suspect the manufacturers of nicotine gum and patches, who not only had to get pre-market approval for their products but waited years before they were allowed to sell them over the counter instead of only by prescription, will be irked by the competition from non-FDA-regulated nicotine inhalers. All of these companies are selling essentially the same thing, however they choose to describe it, and it's quite common for people to use patches and gum as long-term cigarette substitutes, as opposed to "cures" for nicotine addiction. It seems like the artificial regulatory distinctions among different nicotine products can't last. Then again, our drug laws are riddled with such inconsistencies.

'How Would You Like It If You Went to a Wine Tasting and You Couldn't Taste the Wine?'

jsullum@reason.com (Jacob Sullum) — Tue, 06 May 2008 14:53:00 EDT

The Chicagoland International Pipe & Tobacciana Show, held over the weekend in St. Charles, Illinois, was smoke-free this year, thanks to a state smoking ban that took effect in January. Organizers of the event, the country's largest pipe show, had hoped attendees would be allowed to light up as members of a private club:

The hall is strictly staffed with volunteers, convention-goers were to pay $15 to join the club, and attendees were to sign a waiver stating they "freely and willingly accept all the risks of smoking, second-hand smoke, third-hand smoke, and all other risks, both real and imagined, regarding smoking tobacco."

But St. Charles police, DuPage County health officials and anti-smoking advocates didn't buy it.

"This is the first time we've seen such a blatant attempt . . . to actually undermine the law through legal sophistry," said Mike Grady, the American Cancer Society's Illinois director of public policy. "We're very happy with the outcome. This is the perfect example that the law is being enforced."

Pipe smokers, banished to tents outside the convention center, were understandably irked. "How would you like it if you went to a wine tasting and you couldn't taste the wine?" said one. "It's a freedom issue."

[Thanks to Rick Newcombe for the tip.]

One Vice at a Time, Please

jsullum@reason.com (Jacob Sullum) — Fri, 25 Apr 2008 11:53:00 EDT

This week the Atlantic City Council voted unanimously to ban smoking on casino floors. Although the rationale is employee protection, casinos that elect to build separately ventilated smoking lounges, as permitted by the ordinance, have to make sure no gambling occurs there, even the automated kind. Urging the Casino Association of New Jersey to file a lawsuit challenging the ban, Donald Trump complains that it gives slot parlors in the Philadelphia area an unfair competitive advantage.

Meanwhile, The New York Times reported yesterday that charitable groups in states such as California, New York, New Jersey, Washington, and Minnesota have seen a sharp drop in bingo attendance and revenue in the wake of smoking bans:

Managers of charity bingo games...say smoking goes with bingo like peanut butter with jelly. Michael J. Surwill, bingo chairman at Elks Lodge No. 2501 in Ocean Springs, Miss., estimated that smokers outnumbered nonsmokers three to one at the lodge's weekly game....
Charlie Lindstrom, who runs the bingo nights at an American Legion post in Fergus Falls, Minn., said some of his former customers now drove to casinos on Indian reservations, where they can puff away, or across the border to Fargo, N.D., where veterans' organizations are exempt from that state's smoking ban.

One possible solution: allow smoking among consenting adults. Another one: impose a nationwide smoking ban, which would also take care of the accidents caused by drunken smokers looking for bars where they can light up. Which do you think is more likely?

As Goes Bangor, So Goes Maine

jsullum@reason.com (Jacob Sullum) — Mon, 14 Apr 2008 15:21:00 EDT

Last week Maine became the fourth state, along with Arkansas, Louisiana, and California, to prohibit smoking in vehicles carrying minors. Its law, which covers all passengers under 16 and allows primary enforcement (meaning that a driver can be pulled over just for violating the smoking ban), is the strictest so far. The Arkansas and Louisiana bans apply only to little children. California's covers anyone below 18, but a smoker can be cited only if he's first pulled over for some other reason. The main backer of Bangor's car smoking ban, after which the state law is modeled, says next year he will push Maine legislators to raise the cutoff age to 18 and increase the penalty, now a $50 fine. Police can't know the age of people in a car until they pull it over, of course, so the law could provide a handy excuse for hassling young adults who smoke, especially if its coverage is extended to 16- and 17-year-olds. Don't like the looks of that long-haired 20-year-old with a NORML bumper sticker? If he's smoking in the presence of someone who might be a teenager, you've got all the justification you need for a traffic stop.

My previous comments on car smoking bans (and my reasons for thinking they are not justified by the need to prevent child abuse) can be found here, here, and here, among other places.

Camel Snus in the Smoke-Free Tent

jsullum@reason.com (Jacob Sullum) — Mon, 14 Apr 2008 12:11:00 EDT

The Winston-Salem Journal reports that R.J. Reynolds is expanding its test marketing of Camel Snus, a Swedish-style oral snuff that comes in little pouches that users place between the lip and gum. Bill Godshall, executive director of SmokeFree Pennsylvania and one of the few anti-smoking activists who has endorsed smokeless tobacco as a harm-reducing alternative to cigarettes, welcomes the move:

Reynolds' expansion of its test market for snus will provide millions of smokers with less-hazardous alternatives to cigarettes, which is welcom[e] news. It makes sense for Reynolds to gradually expand its test market for snus, as it's a new and entirely different product than cigarettes....Although smokeless tobacco is just as addictive as cigarettes, and should not be used by those who are not addicted to nicotine, cigarettes are about 100 times deadlier than smokeless-tobacco products.

Representing the orthodox quit-or-die position is Matthew Myers, president of the Campaign for Tobacco-Free Kids:

Every new city RJR picked has a clean-air law. This is about RJR doing everything they can to keep people from quitting.

Remember when anti-tobacco activists used to pretend that smoking bans were aimed at protecting bystanders from secondhand smoke? In case you're worried about secondhand saliva, R.J. Reynolds notes that its snus "does not require the consumer to spit."

Godshall co-authored an article about smokeless tobacco that appeared in the December 2006 Harm Reduction Journal. In my column last week, I noted that FDA regulation of tobacco products could impair competition between cigarettes and smokeless tobacco.

Unscrupulous Cigarette Bargains

jsullum@reason.com (Jacob Sullum) — Thu, 10 Apr 2008 12:27:00 EDT

Last week I noted plans to raise New York state's cigarette tax, now $1.50, to $2.75, and estimated that the increase would boost the price of a pack in New York City, which imposes a $1.50-a-pack tax of its own, above $9. On Wednesday, in a completely unrelated development, a guy was busted in New York City with millions of dollars in counterfeit cigarette tax stamps:

The fake stamps would have allowed unscrupulous cigarette dealers to evade nearly $6.1 million in state and city taxes, authorities said....
State excise tax investigator Marybeth Cherubino, who was the lead agent on the case, said that, besides dealing in counterfeit tax stamps, Al-Nablisi bought 375,000 packs of untaxed cigarettes in February from undercover investigators.
''He wanted as much as we could supply,'' she said....
The arrest comes as some authorities voice concern about whether New York state's planned $1.25-per-pack hike in tobacco taxes, taking the price of a pack in the city to about $9, will fuel demand for contraband cigarettes.
Health surveys have found that more than a third of New York state smokers already regularly buy cigarettes from untaxed sources.

If you live in South Carolina and you're planning a drive to New York, you might want to wait until the state legislature approves the new budget. And rent a van.

[Thanks to James Feldman for the tip.]

FDA-Approved Cancer Sticks

jsullum@reason.com (Jacob Sullum) — Wed, 09 Apr 2008 07:00:00 EDT

Last week the House Energy and Commerce Committee overwhelmingly approved legislation that would authorize the Food and Drug Administration to regulate tobacco products. Since the FDA is usually portrayed as a benevolent (if occasionally sleepy) watchdog, you might assume the bill is all about consumer protection. But it's actually aimed at consumer prevention, which is not quite the same thing.

A consumer protection bill that reduced competition, raised prices, restricted choice, blocked information, and made products more hazardous could not really be counted as a success. Yet the Family Smoking Prevention and Tobacco Control Act, which has broad support in both houses of Congress, promises to do all these things in an effort to discourage consumption.

The act imposes new regulatory burdens and advertising restrictions that will help industry leader Philip Morris, which supports the bill, maintain its market-share advantage over smaller cigarette manufacturers, which oppose the bill. The compliance costs and reduced competition are likely to raise prices, which counts as an advantage if your goal is "smoking prevention" but a disadvantage if your goal is to buy a pack of cheap smokes.

Likewise, the bill restricts variety, which consumers like but public-health paternalists do not. Under the act, smokers will be allowed to choose any cigarette flavor they like, as long as it's menthol (which happens to be the one flavor Philip Morris uses). Although people above the age of 18 have been known to enjoy the occasional clove cigarette, Camel Crema, or Kool Caribbean Chill, these flavored varieties have been deemed too kid-friendly and therefore inconsistent with the goal of smoking prevention.

While added flavors (except for menthol) are unambiguously evil, toxins and carcinogens may have a positive role to play if they discourage people from smoking by raising the specter of cancer, heart disease, and emphysema. Hence the bill instructs the FDA to approve a "modified risk tobacco product" only if it would "benefit the health of the population as a whole taking into account both users of tobacco products and persons who do not currently use tobacco products."

To make that judgment, the FDA is supposed to consider "the increased or decreased likelihood that persons who do not use tobacco products will start using the tobacco product that is the subject of the application" as well as "the increased or decreased likelihood that existing users of tobacco products who would otherwise stop using such products will switch to the tobacco product that is the subject of the application." In other words, the FDA could decide to keep a demonstrably safer cigarette off the market because it might attract new smokers or dissuade current smokers from quitting.

Worse, an existing product can be deemed a "modified risk tobacco product" subject to FDA approval if its manufacturer indicates on the package, in advertising, or in any other forum that it's less hazardous than cigarettes. If an executive at a smokeless tobacco company mentioned in a TV interview or an op-ed piece that his products were much safer than cigarettes, which is indisputably true, those products could suddenly be considered illegal.

Here the concern is not fraud but accurate information that consumers might "misuse" (by, for example, switching from cigarettes to oral snuff instead of giving up tobacco altogether). As far as this bill's authors are concerned, you can't handle the truth.

The bill not only authorizes the prohibition of safer tobacco products and the censorship of potentially lifesaving information about relative risks; it gives the FDA permission to make cigarettes more dangerous by ordering reductions in nicotine content. Such a mandate, aimed at making cigarettes less attractive to new smokers, would force current smokers to absorb higher levels of toxins and carcinogens to obtain their usual doses of nicotine.

According to its supporters, this bill, backed by the biggest tobacco company, will enable the FDA to protect smokers from Big Tobacco. Who will protect smokers from the FDA?

Smoking Bans Kill, Part II

jsullum@reason.com (Jacob Sullum) — Mon, 07 Apr 2008 12:33:00 EDT

A new study reported in the Journal of Public Economics finds that smoking bans are associated with increases in alcohol-related traffic deaths. "We observe an increase in fatal accidents involving alcohol following bans on smoking in bars that is not observed in places without bans," the researchers report. They surmise that drinkers respond to bans by driving further to find bars where they're allowed to light up, either because the bars are in a different jurisdiction or because they have outdoor seating. That means more time on the road in a less-than-sober condition:

"The increased miles driven by drivers who wish to smoke and drink offsets any reduction in driving from smokers choosing to stay home after a ban, resulting in increased alcohol-related accidents," the study says.
The authors, Scott Adams of the University of Wisconsin-Milwaukee Economics Department and Chad Cotti, currently at the University of South Carolina, call the results "surprising."
"We thought we would see a reduction," Adams said. "Our first thought was, 'Throw it away, it must be wrong.' "...
The 2-year study looks at highway fatality data involving a driver with blood alcohol content over 0.08 in cities and counties with bans and compares it to incidences in surrounding areas without bans. The study was not funded by outside organizations, the authors said.
Results show an increase in accidents in areas after smoking bans were enacted and near the jurisdiction lines.

A Wisconsin anti-smoking activist quoted by Madison's Capital Times seems irritated by the study and reacts skeptically. But the results need not be seen as an argument against smoking bans (the interpretation I'd favor). They could be seen as an argument for stricter bans that forbid smoking even outdoors and for wider bans that do not allow escape to more tolerant jurisdictions. Adams tells the Times "a well-enforced national smoking ban would get rid of the drunken driving increases related to smoke bans."

The Most Expensive Ingredient in Cigarettes

jsullum@reason.com (Jacob Sullum) — Fri, 04 Apr 2008 17:57:00 EDT

The ABC affiliate in Albany reports that Gov. David Paterson and state legislative leaders have agreed on a $1.25-a-pack increase in New York's cigarette tax, making it $2.75. That will give New York the highest state cigarette tax in the country, surpassing New Jersey's rate of $2.57 a pack. Smokers who buy cigarettes in New York City pay an additional $1.50 a pack, so they will be shelling out $4.25 in state and city taxes, plus the 39-cent federal tax, for a total of $4.64 a pack. They also have to pay sales tax, which in New York City is 8.38 percent. So a pack of cigarettes that would cost, say, $4 without taxes will cost New Yorkers more than $9, most of which will go into city, state, and federal coffers. In other words, the government will be taxing a product disproportionately consumed by poor people at an effective rate of more than 100 percent, reaping bigger profits than anyone else from a business it simultaneously condemns as the foremost threat to public health. It can get away with this punitive levy because the people it's bleeding are an unpopular minority with little political influence. And what do we call this policy? Progressive.

Maybe Tobacco Causes Memory Loss

jsullum@reason.com (Jacob Sullum) — Thu, 03 Apr 2008 19:10:00 EDT

While Barack Obama seems to have exaggerated his illegal drug use, he has at the same time underreported his use of a legal (for now) drug: tobacco. On MSNBC's Hardball last night, ABC correspondent Jake Tapper notes, Obama admitted that he snuck a cigarette here and there after he officially quit in February 2007. Yet when Tapper ran into a smoky-smelling Obama at the Capitol last August, the senator's campaign insisted, even after consulting with him, that he hadn't smoked at all in months.

Obama is a co-sponsor of the Family Smoking Prevention and Tobacco Control Act, currently making its way through Congress. Shouldn't he be setting an example by exercising a little more smoking prevention and tobacco control of his own?

[via TMZ]

Why Smoking Is Worse Than Terrorism

jsullum@reason.com (Jacob Sullum) — Fri, 29 Feb 2008 14:27:00 EST

This ad was produced for the New Zealand chapter of Action on Smoking and Health (ASH) by Doyle Dane Bernbach. As Copyranter notes, the idea is not even original: An anti-smoking ad published in a Dubai newspaper on the 2007 anniversary of 9/11 used the same tasteless concept. The copy in the ASH ad reads:

Terrorism-related deaths since 2001: 11,337 • Tobacco-related deaths since 2001: 30,000,000

This juxtaposition should not be dismissed as mere provocation. For "public health" true believers, the fact that smokers who get lung cancer or emphysema are not murdered but instead die as a result of voluntarily assumed risks does not mean the government has less of a duty to prevent their deaths. As public health theorist Dan Beauchamp puts it, "The historic dream of public health that preventable death and disability ought to be minimized is a dream of social justice," and realizing it means rejecting "the ultimately arbitrary distinction between voluntary and involuntary hazards" as well as "the radical individualism inherent in the market model."

Properly speaking, the collectivist calculus of public health should take into account years of life lost, and the people who died in the the 9/11 attacks were, on average, younger than people who die from smoking-related diseases. But since the latter group is so much larger, it accounts for many more total years of life lost. By this logic, smoking is a much bigger outrage than terrorism, and governments should spend much more money and effort to prevent it than they do to prevent terrorism. Although I am sympathetic to the argument that our government devotes too many resources to stopping low-probability terrorist attacks, I tend to think any amount of taxpayer money spent on saving people from themselves is too much. But that's because I am still subject to what Beauchamp disapprovingly describes as "the powerful sway market-justice holds over our imagination, granting fundamental freedom to all individuals to be left alone."

[via Wonkette]

The Fall of Roman Heart Attacks

jsullum@reason.com (Jacob Sullum) — Thu, 14 Feb 2008 17:50:00 EST

An article in the American Heart Association journal Circulation reports that acute coronary events declined in Rome during the first year after Italy's ban on smoking in public places took effect. Looking at hospital discharge records and causes of death, the researchers found that the age-adjusted rate of acute coronary events among 35-to-64-year-olds was 11 percent lower in 2005 than the average for the five years before the ban. The reduction among 65-to-74-year-olds was 8 percent. The researchers attribute these decreases to the smoking ban. "Smoking bans in all public and workplaces result in an important reduction of acute coronary events," says one of the authors. "The smoking ban in Italy is working and having a real protective effect on population health."

A reduction of 8 percent to 11 percent in heart attacks is nothing to sneeze at, but it's a far cry from the 40 percent reduction anti-smoking activists claim occurred in Helena, Montana, as a result of the smoking ban there. (Trying to explain the inconsistency, the authors of the Italian study emphasize the Helena study's weakness, noting that it "counted only 24 hospital admissions for AMI [acute myocardial infarction] from a small community in Montana in the 6 months after the ban.") Attributing even the relatively modest changes seen in Rome to the smoking ban is iffy, since heart attacks were already declining there before the ban.

In the younger age group, the acute coronary event rate went down from 2000 to 2001, up from 2001 to 2002, and declined steadily thereafter. In the older group, the rate rose steadily from 2000 to 2003, then declined for two years in a row. As Michael Siegel notes on his tobacco policy blog, in both cases there were single-year reductions prior to the smoking ban at least as big as the drop the year afterward. The older group saw a 6 percent drop between 2003 and 2004 (before the ban), the same as the drop between 2004 and 2005 (after the ban). The younger group saw an 8.5 percent drop between 2002 and 2003, compared to a 6.3 percent drop between 2004 and 2005.

So even on their face, these data do not indicate that the smoking ban was associated with an extraordinarily large reduction in heart attacks. If they did, there would still be the question of whether the smoking ban caused the reduction or just happened to precede it. As the researchers concede, the absence of data from a comparable jurisdiction without a smoking ban is a major weakness in the study. Whether as a result of pre-existing (or coinciding) trends or simply by chance, heart attacks are bound to decline in some places after smoking bans take effect; the question is whether they are more likely to fall (or tend to fall more rapidly) in such places than in otherwise similar locations without smoking bans.

I have no doubt that smoking bans, over the long term, will tend to reduce heart attack rates to the extent that they discourage smoking. (The smoking rate in Rome fell from 35 percent to 31 percent among men the year after the ban while remaining about the same among women.) I just think it's highly implausible that the effect would be seen immediately, since epidemiological studies of former smokers show it takes years for their heart disease rates to decline. It's even more implausible that the effect would be due primarily to reductions in exposure to secondhand smoke, as the authors of this study argue. They cite the commonly quoted estimate that secondhand smoke raises the risk of heart disease by 30 percent. But that estimate is derived from epidemiological studies of long-term, intense exposure, mainly among people who live with smokers for decades. Assuming the association indicates a cause-and-effect relationship, you would not expect to see a noticeable decline in risk after one year of smoke-free bars and restaurants.

Even if underlying disease rates don't change that quickly, maybe heart attacks fall because the prevalence of a potential heart attack trigger for people who already have heart disease is reduced. Taken at face value, the numbers from this study imply that something like one in 10 heart attacks among 65-to-74-year-old Italians prior to the ban occurred when they keeled over in smoky bars or restaurants as a result of inhaling tobacco combustion products. I suppose that might be true. But where's the evidence? It's not in this study.

Hooked on the Myth of Instantly Addictive Cigarettes

jsullum@reason.com (Jacob Sullum) — Wed, 13 Feb 2008 14:02:00 EST

Digging through a pile of medical journals, New York Times health reporter Jane Brody discovers that cigarettes are instantly addictive:

Dire warning to all adolescents: You can get "hooked from the first cigarette."

Brody is quoting an article (available for $10) from the December Journal of Family Practice in which tobacco researcher Joseph R. DiFranza warns that "one cigarette may be all it takes to get hooked." But DiFranza immediately back-pedals:

Hooked from the first cigarette?
You bet.
Very soon after that first cigarette, adolescents can experience a loss of autonomy over tobacco, and recent research indicates that this loss of autonomy may play a key role in nicotine addiction.

Notice how the claim of instant addiction quickly becomes a claim that some time after the first cigarette (possibly after the 10th or 100th?) smokers may begin to experience "loss of autonomy," which ultimately could play a role in addiction. And how is this "loss of autonomy" measured? With a 10-point checklist:

Have you ever tried to quit smoking, but couldn't?

Do you smoke now because it is really hard to quit?

Have you ever felt like you were addicted to tobacco?

Do you ever have strong cravings to smoke?

Have you ever felt like you really needed a cigarette?

Is it hard to keep from smoking in places where you are not supposed to, like school?

When you tried to stop smoking (or, when you haven't used tobacco for a while):

Did you find it hard to concentrate because you couldn't smoke?

Did you feel more irritable because you couldn't smoke?

Did you feel a strong need or urge to smoke?

10.

Did you feel nervous, restless, or anxious because you couldn't smoke?

If you answer yes to one or more of these questions, according to DiFranza, you have experienced "loss of autonomy" and are well on your way to a cigarette habit that will give you lung cancer when you're 65. In a sentence that Brody quotes, DiFranza says "three New Zealand national surveys involving 25,722 adolescent smokers who used this checklist revealed a loss of autonomy in 25% to 30% of young people who had smoked their one and only cigarette during the preceding month." How plausible is it that someone who has smoked exactly one cigarette in his life has tried to quit smoking but couldn't, or feels strong cravings for a cigarette, or gets irritable and has trouble concentrating when he can't smoke? Maybe teenagers who have tried cigarettes sometimes say such things because they believe that's what a smoker would say, and they are experimenting with that identity. Or maybe they are just screwing with the people conducting the survey.

Neither DiFranza nor Brody considers these possibilities. Brody is so eager to believe in the overwhelming power of nicotine that she does not even notice how she contradicts herself. After quoting a tobacco researcher who notes that "the vast majority of teenagers who try one or two cigarettes don't go on to become smokers," Brody blithely asserts that "smoking by youngsters...typically leads to a lifetime of smoking."

This sort of misrepresentation reinforces the myth that nicotine is irresistible and inescapable, which is counterproductive for at least two reasons that DiFranza and Brody should be able to appreciate. Teenagers who experiment with tobacco or observe peers who do so will quickly discover that addiction takes more than a single cigarette. Having seen through the scare tactics aimed at stopping them from taking that first puff, they may be inclined to dismiss better-grounded concerns about, say, the long-term health consequences of a pack-a-day habit or the difficulty of giving up cigarettes once you've come to depend on them as a way of relieving stress. And if they do eventually become regular smokers, exaggerating the enslaving power of nicotine will discourage them from trying to quit and from persisting in the attempt.

I commented on earlier attempts to portray cigarettes as instantly addictive here and here.

Asthma Triggers Call for Smoking Ban

jsullum@reason.com (Jacob Sullum) — Mon, 11 Feb 2008 10:36:00 EST

An article in the American Journal of Industrial Medicine attributes the death of a Michigan waitress to an asthma attack triggered by secondhand smoke in the bar where she worked. The title of this dispassionate scientific study is "How Many Deaths Will It Take?" The authors, who say "this is the first reported acute asthma death associated with work-related ETS," conclude "this death dramatizes the need to enact legal protections for workers in the hospitality industry from secondhand smoke." That's one way of looking at it. One might also suggest this death dramatizes the need for people with asthma to take their medication, or to avoid smoky bars if they don't:

[Lead author Kenneth] Rosenman said the woman had asthma since age 2. Her asthma was poorly controlled. She had made four visits to her doctor in the year before her death for flare-ups, and had been treated in a hospital emergency department two to three times that year.
Although she had prescriptions for an assortment of drugs to prevent and treat asthma attacks, she was reported to only use them when she was having breathing difficulty.
On the evening of her death, she had no inhaler with her. When she became sick, she told the bar manager she needed to go to the hospital, then collapsed on the dance floor.
Bar patrons offered an inhaler and the woman tried to use it, but could not. Emergency response workers were unable to revive her and she died shortly thereafter.

Here is a list of asthma attack triggers provided by the University of Virginia Health System. Along with tobacco smoke, it includes pollen, mold, animal dander, dust, dust mites, cockroaches, certain foods, air pollutants, wood smoke, "strong odors and sprays such as perfumes, household cleaners, cooking fumes, paints, and varnishes," "chemicals such as coal, chalk dust, or talcum powder," "changing weather conditions, including changes in temperature, barometric pressure, humidity, and strong winds," and "chemical exposure on the job, such as occupational vapors, dust, gases, or fumes." In addition to casting doubt on the explanation for this particular woman's death, this lengthy list raises the question of why the demand for a ban focuses on just one asthma trigger. How many deaths will it take before people with asthma are protected from perfume and pets?

[Thanks to D-FENS for the tip.]

The Burden of Healthy Living

jsullum@reason.com (Jacob Sullum) — Tue, 05 Feb 2008 18:14:00 EST

A Dutch study reported yesterday in the online journal PLoS Medicine undermines the fiscal argument for a government-led War on Fat, which says how much you weigh is everyone else's business because other people have to pick up the tab via taxpayer-funded health care programs. The researchers found that eliminating obesity would, over the long term, increase medical spending instead of reducing it:

Although effective obesity prevention leads to a decrease in costs of obesity-related diseases, this decrease is offset by cost increases due to diseases unrelated to obesity in life-years gained. Obesity prevention may be an important and cost-effective way of improving public health, but it is not a cure for increasing health expenditures....
Obesity prevention, just like smoking prevention, will not stem the tide of increasing health-care expenditures. The underlying mechanism is that there is a substitution of inexpensive, lethal diseases toward less lethal, and therefore more costly, diseases.

The researchers compared the medical expenses of three hypothetical cohorts: obese people, smokers, and thin nonsmokers. They found that annual costs were highest among obese people until age 56, after which smokers were the most expensive group. But because both groups had lower life expectancies (80 and 77, respectively) than the "healthy-living" cohort (84), they had lower lifetime health care costs as well. Taking the long view, the thin nonsmokers cost the most, followed by obese people and smokers, in that order:

At discount rates of, respectively, 3% and 4% successful smoking prevention would result in additional health-care costs of €7.1 and €3.4 million (assuming costless intervention). For obesity prevention these figures would amount to €1.8 and €1.0 million. Only for discount rates above 4.7% would costless obesity prevention be cost saving. For smoking prevention to be cost saving, the discount rate for costs should be at least 5.7%.

The authors note that they considered only health care costs, leaving out "other potentially substantial costs and consequences" of obesity, such as reduced productivity and "the reduced well-being of family members due to morbidity and premature death." But the former cost would be borne mainly by obese people themselves through reduced earnings, and the latter should be internalized to the extent that obese people care about their family members. (If the government did not force some people to pay for other people's health care, medical costs would be internalized as well.) Notably, the study also left out taxpayer-funded pensions, which increase the burden that healthy-living people impose on the rest of society.

In my 2004 reason article about the War on Fat, I noted that research might find that obesity, like smoking, saves taxpayers money.

[via The Freedom Files]