Unlucky Strike: Private Health and the Science, Law and Politics of Smoking?

By John Staddon and David Hockney

Remember fifty years ago when everyone smoked?Since tobacco found its way into Europe in the sixteenth century, smoking has been a controversial issue. Fifty years ago, almost everyone smoked, and fifty years before that, smokers were in the doghouse; up until the early twentieth century, cigarettes were illegal in a number of U.S. states. Needless to say, smoking has always been a ready source of revenue. It has also been a source of health concerns, both real and imagined. This mixture of pleasure, money and risk that comes with the act of smoking means that it's rarely treated fairly by politicians, health professionals or the public. Nowadays, tough anti-smoking laws are to be obeyed in most corners of the globe.The misinformation about, and unreasoning hostility directed at, smoking and smokers is one of the major concerns of this book. After all, smoking has no public cost. Isn't it just the individual smokers who are at risk?Prompted by this burgeoning fascination, Staddon looks further into the facts. And the more he looks, the weaker the case against smoking as a public health issue becomes. Is ETS really dangerous to children? And if so, how can science prove it? And if smoking has no public cost and the medical case for third-party harm is weak, why are smokers still being victimised? In this provocative, thought-provoking book, Staddon is determined to uncover the truth about smoking. But the truth's not always pretty.

• Language: English
• Publisher: University of Buckingham Press
• Release date: Jan 10, 2014
• ISBN: 9781789551471

John Staddon

John Staddon is James B. Duke Professor of Psychology, and Professor of Biology Emeritus at Duke University. A prolific researcher and writer of international fame, he has authored more than 200 research papers, nine books, and is a past editor of the journals Behavioural Processes and Behavior & Philosophy. Staddon was profiled in the Wall Street Journal in January 2021 for his views on the current problems of science.

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Hockney

Preface

The evils of smoking are a settled issue. Smoking is bad for the smoker and those around him. Smoking causes lung cancer, bronchitis, emphysema, heart disease and cancers in other organs including the mouth, lip, throat, bladder, kidney, stomach, liver and cervix… says a prestigious British report1, feeling no need to document these scary claims. Half of all smokers will die prematurely it adds. Environmental tobacco smoke (ETS) is almost as dangerous as mainstream smoke: ETS has been shown to cause lung cancer and ischaemic heart disease, and probably to cause COPD, asthma and stroke in adults. ETS is harmful to children, causing sudden infant death, pneumonia and bronchitis, asthma, respiratory symptoms and middle ear disease said the Tobacco Advisory Group of the Royal College of Physicians in July 20052. These conclusions are echoed by every recent official report, from the Surgeon General in the US and to the Royal College of Physicians in the UK and comparable bodies in almost every part of the developed world.

I grew up at a time when almost everyone smoked. I did not see smokers falling from their perches all around me and, as it turns out, most of the smokers I have known have lived to pretty good ages. I had not read these grim reports. When I did, I couldn’t help but wonder, just from my own experience, if the dangers of smoking might not be just a wee bit exaggerated.

My personal tipping point occurred when I found out that despite massive publicity to the contrary, smoking has no public cost. It puts individual smokers at risk. It does not put the public purse at risk. Strike one against the received view. Prompted by this surprising discovery, I looked further into the facts. The more I looked, the weaker the case against smoking as a public health issue became. Is ETS really dangerous to children? How do they know? Does it really cause sudden infant death? How do they know that? Proving that smoking can cause an ever-growing list of ailments requires a scientific case that is often impossible to make, for logical, ethical and practical reasons. The case against ETS, in particular, is exceedingly weak.

So, if smoking has no public cost and the medical case for third-party harm is weak, why are smokers victimized in so many ways? I tried to find out – and the answer is not pretty.

Smoking has been controversial ever since tobacco came to Europe in the sixteenth century. Fifty years ago, almost everyone smoked. Fifty years before that, smokers were in the doghouse – cigarettes were illegal in several US states early in the twentieth century. Smoking has always been a ready source of revenue. It has also been a source of health problems, real and imagined. The mixture of pleasure, money and health risk means that smoking is rarely treated fairly by politicians, health professionals or the public. Now, tough anti-smoking laws are almost universal. The misinformation about, and unreasoning hostility directed at, smoking and smokers – and the sight of smokers, usually poor, puffing desperately outside in winter weather – is one reason I wrote this book.

I look at four questions: What should we – government, the state – want? Life, liberty and the pursuit of happiness? – the US Declaration of Independence implies that the ‘joy of smoking,’ should be part of public policy. Is it? How about health? And longevity? Is a long life for everyone an absolute good? And what about productivity – how much should we value the productive fraction of a citizen’s life? In short, what is the common good? Evolutionary biology doesn’t answer these questions, but it should make us skeptical of simple answers to them.

The second question is simply factual: how dangerous is smoking, really? Is it dangerous to others – the problem of secondhand smoke? Well smoking is risky for the smoker, but less risky than most people now believe. It is probably not dangerous to other people.

The third issue is cost: Smoking-related illnesses are costly and painful, no doubt. But we all get sick and die; dying is rarely pleasant; and the fact is that smokers tend to die a bit more efficiently than the rest of us. They cost society less not more than nonsmokers.

Fourth, what do the answers to these questions tell us about policy? Public cost, possible harm to others, the pleasure smokers get from their habit – and the uncertain value of longevity: how should these guide law and custom? Do actual policies in the US and UK make sense in light of the facts? They do not. The dominant attitude to smoking makes little sense. In addition to an instinctive aversion displayed by a few – an aversion that seems to be more pervasive the rarer smoking becomes – the general animus encourages tendentious science, perverts law and tempts politicians into dubious practices. When large amounts of money can be made at their expense, it’s no-win for smokers.

The facts should make society much more relaxed about smoking than it is. But prejudice and perverse incentives in the political and legal systems have pushed policy in the opposite direction. It’s time for a re-think and a redress. Let’s see if you agree.

John Staddon, Duke University, Durham, North Carolina, July, 2013

The only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others.

(John Stuart Mill)

Many thanks to David Hockney for the pictures

1 Public health: ethical issues. Nuffield Council on Bioethics, 2007. A report prepared by a Working Party chaired by Lord Krebs. p. 105.

2 Going smoke-free: The medical case for clean air in the home, at work and in public places. A report on passive smoking by the Tobacco Advisory Group of the Royal College of Physicians, July 2005. See also Passive smoking and children, by the same group, March 2010.

Chapter 1

What is the Common Good?

A Little History

The United States was founded on smoking. The first settlers bet on gold, and lost – but fortunately, John Rolfe arrived soon after with bootlegged Spanish seeds, and the first shipment of Virginia tobacco was sold in London in 1613. Within a year or two the Virginia Company of London began to turn a profit. Tobacco, already popular with the indigenous peoples of the Americas, soon became fashionable: Jamestown's tobacco exports to Europe grew from 10 tons in 1619 to 750 tons in 1639. Saved from extinction by the wonder crop, the new nation was off and running.

But are we grateful? Not really! Even then, not everyone was happy. Tobacco – smoking – is instinctively disliked by some for reasons that are obscure and long predate serious medical research. The revulsion showed itself early in England in the form of a famous ‘counterblaste’ from King James I (he of the ‘King James version’ and advocate for the divine right of kings). James, who was also the author of Daemonologie, a tract against witchcraft, in 1604 carried on his campaign against vice by proclaiming that smoking is A custome lothsome to the eye, hatefull to the Nose, harmefull to the braine, dangerous to the Lungs, and in the blacke stinking fume thereof, neerest resembling the horrible Stigian smoke of the pit that is bottomelesse.1 Living in a time when disease was thought to be caused by miasmas and the Surgeon General was yet to report, James lacked science to back him up. But he had no doubt: smoking is bad.

Now tobacco is back in the doghouse again. Such is the current antipathy, I wonder that the politically sensitive do not blame Christopher Columbus more for bringing tobacco to Europe than for bringing Europeans to the Americas. Of course, the Indians are really to blame for discovering the stuff in the first place but, being Indians, they are more easily forgiven (although not by King James, who thought them pockie, barbarous, slavish and beastly, among other things!). Tobacco is a gift to historians because of its mysterious power to excite violent antagonism. Memory fades, but in fact smoking was illegal in ten US states in 1909. In the 1800s, antismoking was a burning issue writes Cassandra Tate in a fascinating short history2.

In the mid-twentieth century, scientific evidence was added to visceral dislike and the national war against tobacco was on. The Anglo-American broadcaster Alistair Cooke (1908-2004), a discreet lifelong cigarette smoker himself, summarized the US state of play in 1954 as follows3:

For thirty years or more the scandal sheets have printed articles on The Tobacco Habit as a mild variation on their standard high-voltage treatment of such shockers as prostitution, political graft, and the traffic in dope. Most of these pieces, furtively hinting at heart trouble and even tuberculosis, were about as medically convincing as the Methodist credo that smoking stunts the growth4. The tobacco companies paid only sidelong heed to them, with bold hints that, on the contrary, a cigarette was a relaxant, a soothing syrup, and a social grace. The manufacturers were not much better than the Puritans in their respect for the known scientific facts about tobacco and have tended to meet every impromptu accusation with an equally flip defence. In the social history of our time, it may well be that the Reader's Digest will come to claim a decisive part in dating the fashion of cigarette smoking.

Although three separate reports were published [in the US] in 1949, suggesting a plausible relationship between smoking and cancer of the lung, they were folded away inside the pages of medical journals. But a year later the Digest ran an article with the resounding title Cancer by the Carton. This started a lot of talk in America and a noticeable adjustment of cigarette advertising to remind the customer that the tobacco companies keep a 24-hour laboratory watch on every chemical intruder that might possibly sully his breath, tickle his throat or otherwise impair his health and comfort. A few of the tobacco companies had in truth been financing quiet research, but it was concerned with heavier matters than a sore throat or an acrid taste. And, since Americans went on buying cigarettes by leaping billions, the manufacturers maintained their code of contemptuous silence…Two years later the British Medical Journal published a weightier study and it began to look as if the cigarette manufacturers would never be shut of the nuisance.

True enough. The tobacco companies have never since been 'shut of' this particular nuisance – indeed, many have been since shut down by it. But the victory of the anti-smokers was not immediate. A few eminent statisticians questioned both the numbers and their interpretation. It was not until the latter part of the twentieth century that the health case against