How the other half lives (and breathes)

Half of us in the US now live in cities, towns or states that ban smoking in public places, including restaurants and bars (it's nice to be more enlightened than Europe in at least a few things):

Seven states and 116 communities enacted tough smoke-free laws last year, bringing the total number to 22 states and 577 municipalities, according to the group. Nevada's ban, which went into effect Dec. 8, increased the total U.S. population covered by any type of smokefree law to 50.2 percent.

It was the most successful year for anti-smoking advocates in the U.S., said Frick, and advocates are now working with local and state officials from across the nation on how to bring the other half of the country around.

In a sign of the changing climate, new U.S. House Speaker Nancy Pelosi banned smoking in the ornate Speaker's Lobby just off the House floor this month, and the District of Columbia recently barred it in public areas. Arizona, Colorado, Hawaii, Louisiana and New Jersey also passed sweeping anti-smoking measures last year. (AP)

I tend toward a libertarian view and do not necessarily think we need to protect people from themselves in most instances. But smoking in public places endangers others, according to a recent Surgeon General's report:

Nonsmokers exposed to secondhand smoke at home or work increase their risk of developing heart disease by 25 to 30 percent and lung cancer by 20 to 30 percent. The finding is of major public health concern due to the fact that nearly half of all nonsmoking Americans are still regularly exposed to secondhand smoke.

The report, The Health Consequences of Involuntary Exposure to Tobacco Smoke, finds that even brief secondhand smoke exposure can cause immediate harm. The report says the only way to protect nonsmokers from the dangerous chemicals in secondhand smoke is to eliminate smoking indoors.

"The report is a crucial warning sign to nonsmokers and smokers alike," HHS Secretary Michael Leavitt said. "Smoking can sicken and kill, and even people who do not smoke can be harmed by smoke from those who do."

Secondhand smoke exposure can cause heart disease and lung cancer in nonsmoking adults and is a known cause of sudden infant death syndrome (SIDS), respiratory problems, ear infections, and asthma attacks in infants and children, the report finds.

"The health effects of secondhand smoke exposure are more pervasive than we previously thought," said Surgeon General Carmona, vice admiral of the U.S. Public Health Service. "The scientific evidence is now indisputable: secondhand smoke is not a mere annoyance. It is a serious health hazard that can lead to disease and premature death in children and nonsmoking adults." Secondhand smoke contains more than 50 cancer-causing chemicals, and is itself a known human carcinogen. Nonsmokers who are exposed to secondhand smoke inhale many of the same toxins as smokers. Even brief exposure to secondhand smoke has immediate adverse effects on the cardiovascular system and increases risk for heart disease and lung cancer, the report says. In addition, the report notes that because the bodies of infants and children are still developing, they are especially vulnerable to the poisons in secondhand smoke.

The campaign against smoking in public places is having an effect. Recent data on blood cotinine levels in a sample of Americans, a marker for exposure to tobacco smoke, shows a drop of 70% in 20 years. In the late eighties 88% of non-smokers had detectable cotinine levels from exposure to second hand smoke. By 2002, the number was 43%.

Purveyors of tobacco and tobacco products are committing homicide for profit. That's not a libertarian issue as far as we are concerned. It is a matter for the criminal justice system.

Meanwhile we'll settle for banning smoking in public places.

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Where is the science? Reputable studies have shown that smokers are at a highter risk for cancer and heart disease (as well as a plethora of other problems COPD etc.)but I have been unable to find the studies proving heart disease via second hand those rates-25% is HUGE. I don't necessarily disagree with your comments but just as you do with other subjects, I'd appreciate the links to the studies. Are there other sources of cotine in the environment?

DeLuca: No other sources of cotinine as far as I know. The cites to the literature are in the Surgeon General's report I linked to in the post.

I'm having a hard time with this article. I, and millions of others my age were raised in homes where 1) - mothers smoked during our gestation in the womb, and 2) - were raised in homes where we breathed second hand smoke until we were able to move out on our own and choose for ourselves. And yet, we are the same generation that is living longer than ever before. The population is growing older, and causing dire warnings about the solvency of social security in years to come.

If the stats are as bad as this article claims - how can it be that we are older and healthier than ever before?

Sincerely, please educate me.

Chuck: Several things to keep in mind. First, the associations are probabalistic. Not everyone who smokes 3 packs a day for 50 years get lung cancer. In fact only about 10% of them do. More importantly, whatever your age, you are comparing your age cohort to the age cohort of, say 30 years ago (or whatever your comparison is for "we are the healthiest"; compared to whom?).

To say that you had a bad second hand smoke environment when growing up in your age cohort is one thing, but for that to be the deciding factor all the other many factors that determine the health status of the community (air, food, water, nutrition, lifestyle) would have to be the same, too, and it hasn't been. Many other things have changed and affected health status, besides smoking, which is much less now than before and has gone to make you the healthiest generation so far.

Smoking isn't the only or probably the most important thing that affects the status of an age cohort. That's the explanation.

I do not for a moment suggest that inhaling the products of combustion(of any kind) is helpful to health and well-being.But I remain unconvinced by any of the data suggesting that inhalation of second-hand smoke is as dangerous as some would suggest.Also Revere,if,as you say,that only 10% of people who smoke 3 packs a day for 50 years,get lung cancer,then I would suggest that the incidence of lung cancer in second-hand smokers is vanishingly small.I would hate for my teen-age daughter to smoke anything,but nor do I encourage her to "throw rocks" at anyone who engages in this legal practice.Smoking as a habit will be overcome in time. Here in NZ,young people are being encouraged to despise smokers but to partake of legal "party-pills".Mind-altering drugs are OK but smoking is bad.Young people always experiment.What would you prefer....BZP or nicotine?

What would you prefer....BZP or nicotine?

CM: do you think that people who smoke will not also pop some E's? It's not an either-or proposition. Fighting smoking does not prevent the government or anyone else from fighting other health problems as well. Kiddies who smoke will not suddenly become immune to the attractions of other drugs.

There are people who engage in a smelly, dangerous habit that puts a tremendous strain on our health resources (they don't just drop dead in their tracks - it can take agonising years). If by making them embarassed to do such a stupid thing we can actually reduce the practice and *save people's lives*, then yeah, sounds like a good solution to me.

And as for a small number dying due to others' smoking habits: imagine it's only one. Since you like the emotional argument, how would you feel if that one was your daughter who died for no reason, form a preventable cause? It'll be someone's son or daughter. And, of course, it's more than one.

In any case, if I engage in an activity that causes a god-awful stink, even if that stink is utterly harmless, I think it's reasonable that I be prevented from being a public nuisance.

By SmellyTerror (not verified) on 21 Jan 2007 #permalink

"What would you prefer....BZP or nicotine?"

What part of "second-hand" don't you understand?

By truth machine (not verified) on 21 Jan 2007 #permalink

I don't much approve of smoking bans, but we might as well accept that they're going to be pretty much universal in the developed world in a short space of time.

Contrary to what you imply, chnuks of Europe already have smoking bans and they are expanding fast - Ireland, Scotland, England & Wales, Norway, soon Denmark.

I do think it is often an "either/or" question for young people. It is not smoking that attracts young people but the kind of personality that enjoys smoking is often the kind of person others want to be around. So, if young kids need something that sets them apart from "the establishment" I too would prefer cigarettes to alcohol or illicit drugs. How many deaths are linked to driving under the influence? How many marriages, families torn apart? I'd rather spend time with your average smoker than your average drinker. At the very least, they don't tell you the same story multiple times, and they are good to give you a ride home afterward.

Amid piling on Big Tobacco, there's an important global risk assessment history issue here.

Cigarette smoke has extremely low potency in the standard laboratory inhalation bioassays for carcinogenicity. Frankly, also low potency for other respiratory effects in rats and mice. Note "potency," not the slangy use of "toxicity" which conflates gravity of effect with dose.

I disagree with Hecht, below, I believe that rat studies post 2000 demonstrated a lung cancer effect at about 200 mg/m3 exposures. Historically, the clear laboratory result was larynx cancer in hamsters, which otherwise don't get tumors from anything. [I believe this is why IARC will go "sufficient" in animals based on one species, although NTP requires two species to go "reasonably anticipated."]

I have previously opined that, in the current climate, and absent human data, this tox data would argue for putting cigarettes in commerce as a low toxicity substitute for pipes and cigars.

My point is, forget about tobacco exceptionalism. For lung cancer, it's just another particulate, a low or very low potency particulate at that. The effect level for ETS in people, which seems to be around 50 micrograms per m3, is likely higher than these other particulates in people.


Hecht, S.S. (2005) Carcinogenicity studies of inhaled cigarette smoke in laboratory animals: old and new. Carcinogenesis 26, 1488-92.
Abstract: A new study demonstrates that lifetime whole-body exposure of B6C3F1 mice to high doses of cigarette smoke robustly increases lung cancer incidence compared with sham exposed animals. This is the first study to demonstrate a strong effect of inhaled cigarette smoke on lung cancer in an animal model. This commentary attempts to put the new results in perspective with the existing literature on cigarette smoke inhalation studies in animals and discusses strengths, limitations and possible applications of available models.

By Frank Mirer (not verified) on 22 Jan 2007 #permalink

PS regarding the cost issue. Social Security, as a defined benefit pension plan, makes money on smoking. [You could look it up.] I suspect Medicare does too. Medicaid loses money on smoking because it doesn't follow smokers to the end of their lives.

By Frank Mirer (not verified) on 22 Jan 2007 #permalink

I realize that the plural of 'anecdote' is not 'data'; nonetheless, as the child of a long-time smoker who smoked constantly and consistently around me, I can only applaud the initiative, and I wish something similar had been in place when I was a child. I say this from the perspective of someone who asked, on multiple occasions, to not have to breathe in the vile stuff, and who was roundly ignored (if not smacked, for having the gall to ask not to have to choke on a regular basis). (And, yes, my father is an asshole, about more things than just the smoking, but that's beside the point.)

I can't prove that the ill health I suffered from about the age of 12 to the age of 24 was related to my father's smoking, but I find it curious that I was afflicted with multiple bouts of bronchitis during those years, usually 2-5 times a year, each time an illness lasting three-four weeks, and that the frequency and severity of those illnesses tapered off over several years after I left my parents' house (I do not smoke). Correlation does not necessarily equal causation, but I can't help but think there is a connection.

While ordinarily I'm not a supporter of government intrusion into private lives, we accept a certain amount of regulation to protect those who are otherwise incapable of protecting themselves. The fact is, children of smokers do not have the capability to demand that the air they breathe be clean -- especially in a vehicle, where they are, quite literally, captives of their environment. Mandating that a smoker not smoke when children are in the car is no more restricting than mandating that drivers and passengers wear seatbelts -- something already done.

By Kaitlyn Stuart (not verified) on 22 Jan 2007 #permalink

In our house, my parents smoked a lot. My sister was always ill with bronchitis and all three of her kids have asthma.
I was never ill from the effects of their smoking, but my daughter has asthma. Maybe the health problems skip a generation.
Who's to say the huge increases in asthma we are seeing are not caused in part by the smoking grandparents...

By G in INdiana (not verified) on 22 Jan 2007 #permalink

Purveyors of tobacco and tobacco products are committing homicide..

Perhaps it would be more accurate to say that they are facilitating homicide, not to mention suicide.

By secondclass (not verified) on 22 Jan 2007 #permalink

Purveyors of tobacco and tobacco products are committing homicide..

Perhaps it would be more accurate to say that they are facilitating homicide, not to mention suicide.

By secondclass (not verified) on 22 Jan 2007 #permalink

Everyone has made very good points here however, I'd ask that you truly study some of the "facts" before passing judgement or going "Postal". An all-out assault on smokers and the tobacco industry is not the answer.

THE LIE: Smoking statistics do not lie.

THE TRUTH: In this World there are lies, damn lies, and statistics. Never has an argument been won based on statistic alone. They can serve only as a point of departure. In a free and open society people must be allowed to operate as free agents without the fetters of the doomsayers. Life is a risk, but it is that risk which gives it zest. When we allow ourselves to sacrifice our freedoms for the sake of safety, we deserve neither safety nor freedom. Accepting statistics at face value will lead us down that garden path. There are many statistics that can be cited that make the danger of smoking seem mild by comparison.

For example, the use of cell phones, hair dryers, and electric blankets have higher risks that SHS. About half of the smoking population has quit over the past 30 years, yet there has been no comparable increase in life expectancy. The smoke haters will quickly tell you this is because of the effects of second hand smoke. The fallacy of their argument is that if there has been smoking there has also been second hand smoke. In spite of the decline of smoking, childhood illnesses such as asthma, ear infections and A.D.D are rapidly increasing. Cigarettes and/or smoke have about 4,000 identifiable chemicals. Your daily diet has about 10,000 such chemicals. Arsenic which is considered a leading cause of lung cancer is found in significantly larger quantities in a glass of water than in a cigarette.

We both returned from Europe this last winter with heavy unpleasant coughs and impacted sinuses from all of the secondhand smoke which we had inhaled.

It took weeks for us to return to normal health. Ugh.

On unpacking, we noted several wool coats which were otherwise pristinely clean and would normally have just been brushed and hung back up; instead, they had to be immediately sent out for cleaning to get the ashtray reek out of the fabric. Where can I send my lungs for the same treatment?

It is genuinely unpleasant to encounter, and it will have a bearing on our future travel plans.

But beyond that, secondhand smoke is a serious issue in an age when pandemic respiratory illness threatens us all. Smoke particles provide a vehicle to which viral particles can and do bind. This enables the virus to travel longer distances than a cough or sneeze would normally afford. And exposure to the chemical constituents of smoke irritates mucous membranes of the nasal and throat passages, and renders successful infection more likely.

One step which I am sure is not being considered by public health authorities in case of pandemic flu, but which bears thinking about, is to close the tap on cigarette distribution and sales early on.


The Who Study

The World Health Organization's first study on SHS is a textbook example of the right way to conduct an epidemiological study. Unfortunately for them, it yielded unexpected results. They responded by doing a second one, a meta-analysis, that allowed them to extract the results they wanted. This is an analysis of their first study.
Fact: The World Health Organization conducted a study of Environmental Tobacco Smoke (ETS) and lung cancer in Europe.
Fact: ETS is commonly referred to as Second Hand Smoke (SHS). The two terms are interchangeable.
Fact: This was a case control study using a large sample size.
Fact: The purpose of the study was to provide a more precise estimate of risk, to discover any differences between different sources of ETS, and the effect of ETS exposure on different types of lung cancer.
Fact: The study was conducted from twelve centers in seven European countries over a period of seven years.
Fact: The participants consisted of 650 patients with lung cancer and 1542 control subjects. Patients with smoking related diseases were excluded from the control group. None of the subjects in either group had smoked more than 400 cigarettes in their lifetime.
Fact: Three of the study centers interviewed family members of the participants to confirm the subjects were not smokers.
Fact: The study found no statistically significant risk existed for non-smokers who either lived or worked with smokers.
Fact: The only statistically significant number was a decrease in the risk of lung cancer among the children of smokers.
Fact: The study found a Relative Risk (RR) for spousal exposure of 1.16, with a Confidence Interval (CI) of .93 - 1.44. In layman's terms, that means: Exposure to the ETS from a spouse increases the risk of getting lung cancer by 16%. Where you'd normally find 100 cases of lung cancer, you'd find 116.


Because the Confidence Interval includes 1.0, The Relative Risk of 1.16 number is not statistically significant.
Fact: The real RR can be any number within the CI. The CI includes 1.0, meaning that the real number could be no increase at all. It also includes numbers below 1.0, which would indicate a protective effect. This means that the RR of 1.16 is not statistically significant.
Fact: A RR of less than 2.0 is usually not considered important and, most likely to be due to error or bias. An RR of 3.0 or higher is considered desirable.
This rule of thumb is routinely ignored by the anti-smoker activists.
Fact: The study found no Dose/Response relationship for spousal ETS exposure.
Fact: The RR for workplace ETS was 1.17 with a CI of .94 - 1.45, well below the preferred 2.0 - 3.0, and with another CI that straddled 1.0.
Fact: The RR for exposure from both a smoking spouse and a smoky workplace was 1.14, with a CI of .88 - 1.47.
Fact: The RR for exposure during childhood was 0.78, with a CI of .64 - .96. This indicates a protective effect! Children exposed to ETS in the home during childhood are 22% less likely to get lung cancer, according to this study. Note that this was the only result in the study that did not include 1.0 in the CI.
The WHO quickly buried the report. The British press got wind of it and hounded them for weeks.
Fact: On March 8, 1998, the British newspaper The Telegraph reported "The world's leading health organization has withheld from publication a study which shows that not only might there be no link between passive smoking and lung cancer but that it could have even a protective effect."
Finally, the WHO issued a press release. Although their study showed no statistically significant risk from ETS, their press release had the misleading headline "Passive Smoking Does Cause Lung Cancer - Do Not Let Them Fool You."
Fact: In paragraph four they admitted the facts: "The study found that there was an estimated 16% increased risk of lung cancer among nonsmoking spouses of smokers. For workplace exposure the estimated increase in risk was 17%. However, due to small sample size, neither increased risk was statistically significant."
Fact: The press release doesn't mention the one statistically significant result from the study, that children raised by smokers were 22% less likely to get lung cancer.
Fact: The WHO tried to blame the results on a small sample size. However, in the Journal of the National Cancer Institute, where the results were published, the researchers clearly state: "An important aspect of our study in relation to previous studies is its size, which allowed us to obtain risk estimates with good statistical precision..."
It should also be noted that the most likely effect of a larger sample size wouldn't be a large change to the RR, but a narrowed CI.

Lea: Unfortunately not everything you state as fact is a fact. I happen to be an epidemiologist, and a cancer epidemiologist at that, so this stuff is my stock in trade. Among other things it is not true that the true number can be anything in the CI. The most likely number (the number you would place your bet on) is the number estimated from the data, 1.16. Nubers at the ends of the interval are less likely. But that is a detail. You need to understand what you are looking at if you want to cite data like these. Here is the technical meaning, just for reference: If you were to randomly generate data over and over again with the same underlying risks then 95% of the intervals would cover the true number (this is called a coverage probability and is the meaning of a 95% CI). If you had a 99% interval it would be narrower and a 905 interval wider. It is also not true that RRs of less than 2.0 are unimportant. That is utter nonsense and has no basis in science. The importance of a RR attaches to its public health significance, which, in the case of a disease like lung cancer can be very large for a high prevalence exposure like SHS. The precision of an estimate is related to its size, true, but the size of this confidence interval is still not adequate to distinguish this RR from the null, all other things being equal. However it is not just numbers. There is an important argument from biological plausibility which is the most important element in interpreting associations for features of causality.

Thus the most important element in the SHS story, however, is not these data, but the consistent finding of an elevation in risk across many studies combined with its biological plausibility: it is loaded with carcinogens. It is not surprising that tobacco smoke condensate causes lung cancer and so does SHS. It is a surprise to me why you would want to deny this, unless you are a smoker or live with one and the denial is of the psychological kind.

I don't know the source of your "facts" but they are the well known talking points of the cigarette and restaurant/bar lobby against SHS. Smoke if you want, but please don't subject me to it. BTW, the issue is not just cancer but includes heart disease, asthma, emphysema, bronchitis, etc. It is a form of air pollution perpetrated by one person on another.

I am surprised at anyone who would think that second-hand smoke isn't unhealthy at the least and lethal at worst. Quite obviously breathing in someone else's cigarette smoke is bad for you. Any smoky bar will tell your nose and lungs that.

This seems akin to denying human contributions to global warming.

One step which I am sure is not being considered by public health authorities in case of pandemic flu, but which bears thinking about, is to close the tap on cigarette distribution and sales early on.

I think this falls in the same category as the "Let's round up/kill all the dogs & cats in America" school of bird flu preparedness. It's not going to happen, and even discussing the possibility is just going to turn a significant percentage of Americans against the whole idea of preparedness. Yes, smoking is A Bad, Bad Thing, but smokers are addicts, and telling addicts that "public health" requires them to GIVE UP their fixes obviously doesn't work very well for the hardcore subset that hasn't been shamed, nagged, persuaded, or roadblocked into giving up their nasty habit. The useable portion of your argument might be that ALL smokers should be isolated even more stringently than current regulations / social norms mandate... maybe "Smoking will give you the Bird Flu Death" will wean a few more lightly addicted individuals. On the other hand, relatively "harmless" forms of stress-release & self-pleasuring like smoking, or alcohol consumption, are going to be much in demand in any long-term pandemic situation. Perhaps our Flu Preparedness guides should remind smokers to estimate how many cartons they'll need to get through an emergency, since the hardcore nicotine fiends will go to great lengths for a fix?

By Anne Laurie (not verified) on 22 Jan 2007 #permalink

On the other hand, relatively "harmless" forms of stress-release & self-pleasuring like smoking, or alcohol consumption, are going to be much in demand in any long-term pandemic situation.

Two thoughts occur.

One is that in any of the genuinely bad panflu scenarios, where grid electricity and liquid fuel deliveries will become irregular, and all other productive economic activities will undergo a decompounding effect because of those, then simply *obtaining* either tobacco or liquor will promptly become moot once the local caches are exhausted.

The other thought is that if there is a bug around with a case fatality rate anywhere above five percent or so, and if it becomes generally known that smoke can help it to propagate, it will be as much as a smoker's life is worth to light up in any public situation.


"that children raised by smokers were 22% less likely to get lung cancer. "

That's because they realize it is a filthy habit that makes their clothes, hair, and bodies smell bad and they never take it up.

By G in INdiana (not verified) on 23 Jan 2007 #permalink

I smoke a pipe; I enjoy it immensely (oral gratification without calories), it's only mildly addictive (less so than coffee for most of the coffee-drinkers I know), and the health risks are insignificant. I don't smoke in indoor or confined spaces where anyone might object, even my own vehicle when driving with passengers or my own house when nonsmoking friends are visiting. This is a matter of common courtesy: thou shalt not annoy thy fellow humans. I do not need a bunch of puritanical moralists attempting to classify me as something less-than-equal in order to satisfy their addiction to the sense of self-righteous superiority.

Substitute the word "homosexuality" for "smoking" and you sound just like the right wingers. The same puritanism, the same moralizing tone, the same self-righteousness and straw-man arguements and the same control-freak desires to put Big Brother in the living room if not the bedroom. And now we have "smoke carries panflu." Cook up a fiction, whip up a frenzy, and use it to start a pogrom. Where have we seen this before, eh? "Homosexuals recruit.." and "...will destroy your heterosexual marriage..."

If ambient smoke is so bad for your health, then what's good for the tobacco goose is good for the automotive gander and we should be banning automobile exhaust from public places. In fact we should declare traffic jams to be major public health hazards, and this isn't even including the issue of CO2-caused climate change that threatens to make panflu look like a short trailer for the docu-drama to follow. But oh the silence is deafening! By the way, the smoke from witch-burnings is a real killer.

If you're really concerned with disease risk, then you should have nothing to say about pipe and cigar smokers, and in particular pipe smokers who tend to live slightly (but not statistically significantly) longer than nonsmokers. Comparisons with extreme sports such as mountain climbing are also relevant here, as per the huge cost of sending rescue teams up mountains to pull frozen corpses out of the snow or scrape their splattered remains off the rocks below.

While we're at it, how'bout that deafening silence about the stress pandemic and the illnesses it causes? I'm sure you know the studies that link "sense of helplessness" on the job with cardiac risk, quantified in terms of blood pressure as well as health outcomes.

Much easier to pariahfy those whose health risks are related to activities that give them pleasure, than to take a close look at the health risks of activities that cause displeasure, such as automobile commuting and miserable jobs. After all, pleasure is sin, and suffering is noble, eh? Much easier to single out a specific industry as evil, than have to look at the culture of relentless competition and mind-numbing frustration that has become as common as head-louse infestations in the Middle Ages.


You want to get rational about tobacco, try this: Two modest proposals.

One, mutual respect and good manners. This means no more stigmatizing and blaming and singling-out. It means encouraging a generalized attitude of being considerate of others. Not smoking where it bothers nonsmokers is one item among many, starting with washing hands after using the toilet, covering one's mouth when coughing or sneezing, obeying traffic rules, and keeping one's nose out of other peoples' private lives.

Two, tax the products to cover the empirical health costs.

First of all, do away with the "sin taxes." The whole concept of sin tax is another example of moralizing self-righteous puritanism that violates every progressive and libertarian precept; it imposes upon others based purely on cultural biases, it is a means by which majorities can extort money from minorities "because they can," and it harms the legitimacy of other taxes imposed on more rational grounds.

Second, allocate a new tax based on actual health costs. For example if 10% of cigarette smokers get illnesses that require on average $500,000 in treatment cost, then allocate the cost accordingly: $50,000 per cigarette smoker, which at (conservatively) 1 pack per day over a period from age 18 to age 68 comes to $1k per year or $2.73 per pack. And use that money solely to treat cigarette smokers' illnesses, not to go moralizing to smokers about quitting. This is pay-as-you-go and no sane person, smoker or otherwise, could object. It internalizes the cost-externality of cigarette-related health risk to the public health system (assuming a single-payer system).

Yes, I'd get off lightly because the health cost of pipe smoking are negligible, and cigar smokers would get off almost-as-lightly for the same reason. Tough, that's the consequence of empiricism compared to moralism and puritanism. And while we're at it, people who engage in extreme sports such as mountain climbing would be paying a proportional tax on their gear, to pay for the cost of rescue squads and surgeons and suchlike.


If you keep up the puritanical moralizing, you're going to lose votes faster than Bush has been losing two wars. If you stick to even-handedness and empiricism, you might get somewhere. But you are going to have to learn to live with the fact that some people mightily enjoy things that you do not, even things that disgust you. I had to deal with that long ago with people who enjoy eating lobster and crabs (eww, gross!). In the long run it's not so hard. Really.

g510: I'm not sure to whom your remarks are directed, but mine are not directed to those who are addicted or the addicted whose addiction involves only themselves (as you say is the case for you). I do direct my ire at the drug pushers who hurt those addicted (mainly cigarettes, but pipe and cigars are a cause of head and neck cancer, which is pretty nasty). For the record, I am for legalizing drugs and am not for making cigarettes illegal. I believe banning smoking in public places is protection for those of us who don't smoke. You don't have to see too many people die of smoking-related illness (and I have seen many) to have strong feelings about businesses that promote and enhance it. It is not like eating lobster, alas., although it is more expensive.