Health Promoters Vs. Health Nazis: A Look Behind the "Tobacco War"

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A
week ago in a Florida courtroom, a jury handed down a $144.8 billion
judgment against cigarette manufacturers in a class-action lawsuit
on behalf of sick smokers. The number of smokers supposedly involved
varies depending on which account we read: in some it is 500,000;
in others, as much as 700,000. The event, in any case, sent shock
waves through the tobacco industry. While the case is being appealed
and it is doubtful that anyone will be forced to come up with $144.8
billion, this is clear indication of the escalating war against
"big tobacco." The Florida verdict, even if slashed dramatically
by a higher court, could still be high enough to force an increase
in the price of cigarettes as a perceived need to defend against
lawsuits is passed on to consumers. Foes of smoking may say, "Good!
If people can't afford to smoke they'll quit, and then they'll be
healthier." This raises a lot of questions. First, will the
smoker quit or pay the higher price (possibly neglecting other responsibilities)?
More importantly, is a higher priced cigarette pack just the first
step toward more and more de facto coercion of consumers
in the name of public health? Finally and most importantly, what
is the relationship between government – including the courts and
those who would use them as weapons against entire industries – and
the health of the public?

Before
continuing, a few personal remarks. I don't smoke. I've never been
tempted to smoke: not even once. I'm not too crazy about being around
a lot of cigarette smoke. I've occasionally tried to convince friends
who smoke that they shouldn't, and made similar arguments to those
of smoking's political foes. Those who smoke place themselves at
risk not just for lung cancer and heart disease, but because of
the stresses foreign substances (tar, nicotine, etc.) place on body
systems, their tolerance to disease generally is reduced. Smoking
has, after all, been linked with many long-term health problems.
It has social disadvantages as well. Frankly, in my judgment as
a red-blooded American male, an otherwise attractive woman who lights
up is a turn-off. I presume I speak for other nonsmoking men. One
of the major disadvantages of nightclubs and many restaurants is
that when you walk out, your clothes reek so badly from cigarette
smoke that you feel like throwing them away.

So
what is the problem? I'll begin by asking readers to reread the
preceding paragraph and note the first-person references in it.
Not smoking is, first and foremost, a personal decision of mine,
just as others' decisions to smoke are personal decisions of theirs.
This is our starting point. As a person who wants to live in a free
society as well as be a nonsmoker, it is clear to me that I have
no business attempting to impose my personal decisions on others,
including using government or the court system as a means. I can
persuade others not to smoke with medical reasons and offer them
advice on how to go about quitting; but once I've presented my case
I must shut up and let them decide; I cannot legitimately coerce
them into quitting. Of course, those who own businesses are free
to post No Smoking signs; many workplaces joined the war
against smoking when their owners declared them smoke-free zones.
This is entirely legitimate; if we take property rights seriously,
then owners of a workplace have a right to regulate the conduct
of those they admit onto their property and to reject certain forms
of behavior. But then they have to weigh the potential costs, if
their employees or customers decide to go elsewhere.

Now
to be sure, the medical case against smoking is quite real. Because
of this it is difficult if not impossible to have much respect for
the tobacco industry. (Nor is it possible to respect politicians
who pander to "big tobacco" with subsidies in exchange
for votes.) After all, the health problems associated with smoking
have been known for years. However, the real issues involve what
follows from this. To be as precise as possible, what is, or should
be, the logical relationship between the following two sets of statements:
X is bad for your health and the government should attempt
to ban X; and X is good for your health and the government
should affirmatively compel X? How one answers these questions
distinguishes health promoters from health nazis. In a free society
there is no logical relationship between the first and second statement
in each pair, because a free society does not dictate health choices
to individuals. That is not a function of Constitutionally limited
government. Have we learned nothing at all from previous prohibition
movements, be they the alcohol prohibition disaster of the 1920s
or today's hopeless "war on drugs"?

Today,
probably all who smoke know the risks. How could it be otherwise?
So why do they still smoke? Because whatever personal enjoyment
or benefit they believe they receive from lighting up outweighs,
in their subjective opinion, the long-term risks. All one has to
do is ask a smoker why he or she smokes. "It helps me relax."
"It keeps me from gaining weight." "All my friends
smoke." Etc. Now of course it is extremely unfortunate that
there are elderly people who became smokers when they were teenagers,
and did not learn of the risks until much later. But we cannot make
this segment of the population the measure of public policy any
more than we can design a public policy banning all gun ownership
because a relatively tiny handful of children and teenagers were
accidentally killed last year playing with guns. Freedom isn't free,
and a certain amount of risk is one price we pay for having what
freedoms we have managed to retain.

Of
course, we are all better off when we make responsible health choices.
There are plenty of other activities we should refrain from besides
smoking, and others we should engage in as integral components of
healthy living. We should, for example, steer clear of fast food
despite its conveniences because of its high fat content, and because
too much meat affects one's cholesterol levels. We should maintain
a diet with plenty of fiber, because fiber increases the efficiency
of the gastrointestinal system; and unless your gastrointestinal
system is healthy, none of your other body systems will be healthy – not
really. Finally, most of us need to exercise more, if only to take
long walks every couple of days.

These,
of course, are standard health promotion pitches. The real question
is do we want them coming from health bureaucrats with potential
enforcement power? Because if the legal war against cigarettes succeeds,
it is legitimate to wonder what they will go after next. Will they
target the fast food industry, for example? (Doing so would open
up a minefield of unintended side effects, since the fast food industry
is a major employer for unskilled teenagers.)

One
of the things that makes health promotion such a difficult affair
is that people's motivations are all different, and the motivations
of particular individuals differ from time to time. The most precise
statement of this is to be found in Austrian economics, in the form
of the subjective theory of value. But any close observer of human
motivation soon realizes that this is not a mere economic concept.
It has wider ramifications. It certainly applies to our health choices.

Moreover,
changing a health habit is not an automatic matter of will power.
We are more creatures of habit than we think. Ending any habit and
replacing it with another one is not automatic but can take a long
period of intensive effort. This does not mean that smokers cannot
assume responsibility and kick their habit. Today there are countless
smoking cessation programs and support groups available to help
people quit. But the point is, participation in all such programs
both is and must be voluntary.

This
cuts to the bottom line. Because of the effort it often involves,
changing a health behavior, be it smoking or anything else, cannot
be forced on someone from the outside. That is no means of achieving
real and lasting positive change. The person asked to make the change
has to want the change – perhaps very badly. This is all the
more reason for keeping bureaucrats and legal eagles out of the
picture. The best support for quitting smoking will come from spouses,
other family members, work associates, others quitters, and friends
who believe they have a stake in the outcome. It will not come from
a faceless bureaucracy headquartered miles away whose personnel
are guaranteed their government paychecks whether or not their programs
work.

There
is one final and, to my mind, very telling argument against allowing
health bureaucrats, or the court system, to coerce individuals indirectly
by setting out to destroy entire industries. Suppose, just for a
minute, we had the kind of society the health bureaucrats present
as their ideal in, for example, overblown statements such as Healthy
People 2000 (now replaced, unsurprisingly, by Healthy People
2010). Suppose we had a society in which nobody smoked, everybody
adhered to proper diets and exercise programs, etc. In this case,
what would the health bureaucrat do? Have you ever known
any bureaucracy to solve the problems that constitute its bread
and butter? This suggests that the real agenda of the health bureaucrat
is not a healthy public, but a dependent and compliant
public – a public dependent on the bureaucrat for its health needs – and
if some of the dependents achieve good health, fine. This is part
of the ever-widening edifice of command and control that defines
our Federal Government today, and is being mimicked at state and
even local levels. It enjoys support from a misguided public sold
on the idea, so detrimental to freedom and personal responsibility,
that if x is bad for you then it is the Government's job
to fight it.

The
medical case for not smoking is what it is. But we will all be better
off when we act on this information voluntarily. There is a lot
more to public health, after all, then just the physical health
of our bodies. I would not call a society of compliant, programmed
human sheep healthy in the broader sense of this term even
if none of them smoked. If we allow bureaucrats, judges, and confused
juries try and create a smoke-free society by force, the costs will
definitely outweigh the gains.

July
22, 2000

Steven
Yates
is the author of Civil
Wrongs: What Went Wrong With Affirmative Action
(San Francisco:
ICS Press, 1994) and numerous articles and reviews. He lives and
freelance writes in Columbia, South Carolina.

Steven
Yates Archives

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