
Smoking is Worse Than You Imagined - danso
http://www.nytimes.com/2014/01/19/opinion/sunday/smoking-is-worse-than-you-imagined.html?action=click&contentCollection=Books&module=MostEmailed&version=Full&region=Marginalia&src=me&pgtype=article
======
pmr_
As a smoker I highly support fair taxes on tobacco. I would welcome the
additional incentive to finally stop smoking and I believe that every
individual has the right to hurt itself as long as it paying for the damage
and not dropping the bill on others (I also think this applies to driving
cars, eating unhealthy food, and so on).

One problem in Europe is that tobacco taxes are not bound to be used to
bolster the health care systems or smoking prevention programs (In Germany the
2002 and 2003 tax raises have been used for funding the War on Terror).
Another problem is, as shown by the article, that our damage estimates are
very likely to have a large error margin.

If think if we could improve our damage estimates, use the estimates to
continuously adapt taxes, use the tax income to pay for the damage and to
prevent spread of the problem the problem could be solved.

To me it seems there is a gap for technology to make those things possible.

~~~
netcan
I disagree with this type of thinking. I think we need to be careful of
mandates begetting mandates. I agree with public health spending. I think it's
a good thing. But I don't think it should (morally) cost us personal freedoms
like that. Paying for health does not give the public mandate over the
private's eating/exercise/smoking habits. That is the road to totalitarianism
and I don't think there is any reason to travel down it.

Said another way: A public responsibility towards the private person's health
_care_ is not a wide responsibility for their health and it does not translate
into a right to make an individual's health decisions for them.

~~~
pmr_
I think you misunderstood me or I wasn't clear. I'm not saying an individual's
habits should be regulated or certain products should be banned, but that
users of damaging substances should carry the cost those habits cause. This is
the opposite from restricting individual freedoms: it makes your more directly
responsible for the actions you take and makes you free to take those actions
without ever burdening your fellow citizen. Maybe all those things just apply
if there is mandatory health care, but I'm not really used to reason in
systems where this isn't the case.

~~~
netcan
I don't think I misunderstood you.

If users of damaging substances (including for the sake of argument, big macs)
are required "carry the cost those habits cause" indirectly via taxes, we are
taking a step towards totalitarianism and away (in my opinion) from the
democratic value that brought about the public health care in the first place.

Education is a publicly provided good. We don't require people who have
children to pay more taxes (the opposite, in fact). In any case I've heard
that life prolonging habits can actually be a bigger drain on public purses as
100 year olds have spent many years living on social welfare payments and
using up expensive medical resources. Most medical expenses are at the end of
one's life and everyone dies eventually.

To the extent that socialist/social welfarist policies/ideals are incompatible
or at odds with democratic values, I think we should lean towards democracy.
In this case, that is fairly simple: stop saying cigarette tax pays for lung
cancer drugs. It doesn't and it shouldn't. The right to make ones own
judgments and maintain the responsibility oneself is an inseparable part of
individualism and democracy. I also think its an important part of secularism,
but thats going into a stretch.

~~~
pmr_
We require people with children to pay less taxes or subsidize them and
provide those children with education because the value educated people
provide to society is far higher than the actual cost of educating them.

I would wager the same goes for long-lived, but healthy individuals, but this
seems very hard to measure and I cannot find any numbers. So I would
understand if you don't see this as a convincing argument. Especially since
"value" should mean more than just money here.

How do you keep people "maintaining the responsibility oneself" if you just
let them continue to hurt themselves and then provide therapy funded by the
general public?

~~~
netcan
>> _" value" should mean more than just money here._

This is the central point, to me. I don't think of public education as a way
for a government to increase taxes from future generations. That's horrible. I
really hate listening to politicians and bureaucrats talk like that. Amoral
creeps. Luckily, it's impractical for reasons like the one you mention.

Governments (societies) educate children for the same reason parents do:
because it will help those children, it will help the family/society &
(importantly) for its own sake. Basically we do it for them, the children. We
also take care of the sick, to help the sick.

Public welfare, education, health care (not health) are goods, even if they
are not frivolous goods. We buy them when we can afford them. They are not
investments or money saving exercises.

I really do think this political culture that has become established in Europe
(also the US, I think) where politicians are constantly claiming how some
policy is really an investment or pays for itself is nasty rhetoric. It's
usually an ignorant statement or outright lie, for one thing. Even it these
statements where in fact accurate statements about something measurable it
would still be a nasty, amoral & totalitarian way of looking at the world.

There is not way, for example to justify elderly care under this view. They've
already paid taxes, now they just cost us money.

>> _if you just let them continue to hurt themselves and then provide therapy
funded by the general public_

I really do see this view as incompatible with democracy and I'm surprised
more people aren't as creeped out by it as I am. Like I said, I don't think
you are facing a real problem here that needs to be solved. People already
have a strong interest in their own health and well being. There is no
conflict of interest.

People are of course imperfect and weak, the human condition and all that.
Their decisions are sometimes bad. Human institutions are also imperfect. When
they are perverted by their own weaknesses and make bad decisions on your
behalf it can be horribly oppressive. You are basically (I'm deducing,
apologies if I'm misrepresenting) advocating increased supervision and
pointing to the bill as your source of authority, or (even worse) the lost
taxes society might have received had the person remained healthy.

What kind of morals is this?

------
jokoon
My mother smoked when I was growing up and when she was pregnant.

Each time I inhale a tiny bit of cigaret smoke, I immediatly feel bad and
start coughing. Really feels like a poison.

Here in france, a pack of cigaret will soon cost 7 euros. I'm glad. It's a
great way to penalize people while reducing the deficit, and encouraging them
to stop smoking.

Each time I hear someone complaining about the cost of cigaret in france, I
tell them "well it's a great way to finance chemotherapies".

Smoking is a luxury. When you feels you don't have a sharp mind or enough
energy at work, and you boosts yourself with a coffee and a cigaret, okay, but
I don't think you really need to have those boosts. I'd prefer getting fired
instead than competing with drug addicts.

~~~
hamax
> "well it's a great way to finance chemotherapies"

That's not how it works. Cigarette tax doesn't go directly to the healthcare
budget. At least in most countries.

> Smoking is a luxury.

And a very strong addiction.

~~~
jokoon
> That's not how it works. Cigarette tax doesn't go directly to the healthcare
> budget. At least in most countries.

French healthcare system always finances 2/3 of most cares. I think
chemotherpy is included. I don't know about how things happen in the US
though.

> At least in most countries.

Most developed country have a pretty socialist healthcare system.

~~~
contingencies
_Most developed country have a pretty socialist healthcare system._

This. US readers take note. Of course, it's going away pretty quickly ...
almost everywhere.

------
hansy
So smoking tobacco is bad. Got it. Now what about marijuana? Less bad?

I don't think I've ever read a report on marijuana yellow-taped with as many
warnings and dangers as those found in tobacco reports. Is this because not
enough evidence has been gathered around the dangers of weed?

~~~
swombat
Weed is just as bad to smoke as tobacco, especially since it's often (though
not always) mixed with tobacco.

One big difference, though, is that weed itself is only very mildly physically
addictive, and in a small percentage of the population. This is as compared
with tobacco, which is more addictive than heroin, for pretty much everyone.

Also, weed contains chemicals, like THC, which are not so harmful, and can be
ingested in ways other than smoking (e.g. inhalers). And unlike cigarettes it
has benefits as a painkiller for people for whom other painkillers no longer
work (e.g. terminal cancer patients, who probably don't need to worry about
getting lung cancer 20 years from now).

Overall the scorecard seems to be:

Smoking weed is probably just as bad as smoking cigarettes, but has a number
of benefits over cigarettes and is nowhere near as addictive. That makes it
less harmful overall.

~~~
WA
Tobacco (nicotine) is also only mildly physically addictive. The main part is
psychological addiction.

Weed has also a number of negative side effects over cigarettes. THC, after
all, is a psychoactive drug and some people develop a psychosis from smoking
weed. This doesn't happen when smoking tobacco.

It depends entirely on what you're comparing here. Do you compare smoking 10
joints vs. 10 cigarettes or 1 joint vs 10 cigarettes (per day? per week? per
month?)? If one smokes as much weed as tobacco, he might develop way worse
symptoms than someone who "just" smokes cigarettes.

~~~
swombat
From wikipedia: (
[http://en.wikipedia.org/wiki/Nicotine](http://en.wikipedia.org/wiki/Nicotine)
)

> _According to the American Heart Association, nicotine addiction has
> historically been one of the hardest addictions to break, while the
> pharmacological and behavioral characteristics that determine tobacco
> addiction are similar to those determining addiction to heroin and cocaine._

NHS: (
[http://www.nhs.uk/chq/Pages/2278.aspx?CategoryID=53](http://www.nhs.uk/chq/Pages/2278.aspx?CategoryID=53)
)

> _Cigarettes contain nicotine, which is highly addictive._

> _Even if you want to quit smoking, you may find it difficult because you’re
> addicted to the effects of nicotine. Some research has suggested that
> nicotine can be more addictive than heroin._

"Only mildly physically addictive"...

~~~
jimzvz
A big problem with research into nicotine is that it has been conflated with
tobacco smoke. You should really substitute "nicotine" with "tobacco smoke" in
these sentences.

~~~
swombat
There have been plenty of studies on nicotine itself, in isolation...

------
bromagosa
So, briefing:

    
    
      «There is no doubt who is to blame for this mess, the report says. It is the tobacco industry»
    

And then:

    
    
      «The new report rightly calls for more vigorous tobacco-control efforts, including an increase in cigarette taxes to drive up the average price of cigarettes to at least $10 a pack to prevent young people from starting to smoke; an antismoking mass media campaign by government agencies that would run year-round; and new rules extending smoke-free indoor protection to the entire population, double the current level.»
    

Let me understand... the solution is not to punish the ones who undoubtedly
are to blame for this mess, but the general tax-paying public and the smokers
themselves?

~~~
argonaut
How does that punish the general tax-paying public?

The burden of taxes falls on both consumer and supplier.

~~~
goblin89
Can that anti-smoking campaign be guaranteed to be financed exclusively by the
taxes collected from cigarette purchases?

~~~
argonaut
Ah. Regarding the mass media campaign, it may be possible that the money spent
is recouped in healthcare savings. It's very much up in the air the net
economic effect of something like that.

You can't guarantee that it's going to have a positive/neutral effect, but
neither can you guarantee it's going to have a negative effect on the public,
either.

------
stevewillows
As a smoker who is constantly in the 'I'm quitting..' phase, is there a reason
that cigarettes are so bad? Is the burning of tobacco itself lethal or are the
additives the principal killers?

~~~
BugBrother
Snus is a relevant data point to support Synaesthesia's claim. It is (non
smoke) tobacco, but won't give you cancer or destroy your lungs (still not
healthy with nicotine, of course, but many times less bad).

[http://en.wikipedia.org/wiki/Snus](http://en.wikipedia.org/wiki/Snus)

~~~
russelldavis
> won't give you cancer.

Untrue. "Smokeless tobacco is a major cause of oral cancer, pancreatic cancer,
and esophageal cancer."

[http://www.webmd.com/smoking-cessation/features/snus-
tobacco...](http://www.webmd.com/smoking-cessation/features/snus-tobacco-
health-risks)

~~~
BugBrother
A better reference than Wikipedia? :-)

E.g., Wikipedia says: _Thus far, the evidence specifically implicating snus in
pancreatic cancer is only suggestive.[25][26]_

Your link say: _[Scandinavian] snus users have a significantly higher risk of
pancreatic cancer._

That is a contradiction. Wikipedia has references.

And snus, according to both references, is less bad than snuff. Your quote
("Smokeless tobacco") generalizes over the same group.

------
jessedhillon
How long will it be until we can definitive statements about e-cigarettes? I
hate being in a bar or club, or fucking anywhere really, and seeing people
smoking those things indoors. But if asked whether that smoke is actually
harming me, I couldn't say.

~~~
jgroome
That's a shame. The "smoke" from e-cigarettes is just vapour, and no more
harmful to the people around the user than steam from a kettle.

However, there's a discussion to be had here, and it's possibly more important
than the one surrounding cigarettes and second-hand smoke. It's a brand new
industry and a brand new habit that people are only starting to adjust to.

Ecig manufacturers are, at present, allowed to advertise their product
publicly, and sell them as a lifestyle choice. They're even allowed to
advertise on TV, something that the tobacco boys haven't been able to do for a
very long time ([http://www.dailymail.co.uk/news/article-2517504/VIP-E-
cigare...](http://www.dailymail.co.uk/news/article-2517504/VIP-E-cigarette-
advert-Im-Celebrity-provokes-parents-outrage.html)).

As an ecig user myself I find myself using it indoors regularly. I'm harming
nobody but myself with it. But that's the problem - it's normalised the
recreational ingestion of nicotine, and it's only going to become more
popular.

Smokers, even reformed smokers like myself, aren't going to change their
habits unless they're forced to do so. So while many people are put off by
indoor ecig use, until the law changes to forbid it, you're just going to have
to deal with it.

~~~
humbledrone
> _That 's a shame. The "smoke" from e-cigarettes is just vapour_

Saying "just vapor" means nothing here; consider "just chlorine vapor," for
instance. Obviously the substance that has been vaporized is the important
part. The most common e-cigarette vapor, propylene glycol, does have very low
toxicity. But you still might not want to inhale it constantly -- no
longitudinal, long-term study has been performed that simulates the
e-cigarette use of PG and shows beyond doubt that it is safe.

> _and no more harmful to the people around the user than steam from a
> kettle._

Nicotine is a known carcinogen, and e-cigarette vapor contains nicotine. Tea
kettles do not release vaporized nicotine. The e-cigarette vapor may have a
low concentration of nicotine after being exhaled, but again, nobody has
extensively studied the results of breathing second-hand e-cigarette vapor
over a long time period. Your assertion is completely unsupported by evidence.

> _I 'm harming nobody but myself with it._

You cannot back that up with evidence. This is your guess, and it could be
wrong.

Now, I happen to think that it is _likely_ that e-cigarettes will be shown to
be much less dangerous than tobacco cigarettes. But my opinion, just like
yours, is meaningless since it's not backed up by evidence.

~~~
Semaphor
> Nicotine is a known carcinogen

Is it? All I can find is that it promotes tumor growth if the tumor is already
there but doesn't cause them by itself.

>> I'm harming nobody but myself with it. >You cannot back that up with
evidence. This is your guess, and it could be wrong.

Clearstream [1] was done and at least one other study (can't remember the name
atm). Nothing completely conclusive but at least it points towards it being
rather safe.

[1]
[http://clearstream.flavourart.it/site/?p=1014&lang=en](http://clearstream.flavourart.it/site/?p=1014&lang=en)

~~~
humbledrone
> _Is it?_

I may have been too conclusive there; the CDC only says:

 _" Nicotine is a teratogen (capable of causing birth defects). Other
developmental toxicity or reproductive toxicity risks are unknown. The
information about nicotine as a carcinogen is inconclusive"_

[http://www.cdc.gov/niosh/ershdb/emergencyresponsecard_297500...](http://www.cdc.gov/niosh/ershdb/emergencyresponsecard_29750028.html)

~~~
Semaphor
Yeah, I wouldn't say that Nicotine is not a toxic/dangerous substance, it
certainly is :)

------
timonv
Smoking costs billions? Productivity? An 'even higher' increase in risk of
lungcancer? And there are no other factors at play _at all_? So now it's going
to be a war on smokers again, is it? What a terrible causation-correlation
fuck up.

ftr, I quit smoking a year ago. And happy I did.

~~~
JoeAltmaier
Yeah the article sucks. It also takes pains to throw blame around with no
citation and no logic. Its apparently the fault of tobacco companies alone,
because they are evil. Not for instance the smokers. Or those dang filters
that apparently are just as bad as tobacco. Who's fault are those?

------
rartichoke
I smoked a pack a day for about 10 years and have quit for 2 years without
using anything special or e-cigs. The quitting process took 3 days.

If anyone who wants to try and quit here's what I did:

1) Make sure you want to quit because if you don't seriously want to quit then
you won't no matter what.

2) Smoke less and less every day until you get to zero. This will vary for
everyone, I personally did it as fast as I could handle it which mainly
consisted of only smoking after meals after I went from 1 pack a day down to
half a pack a day.

That's seriously all there is to it. It'll be a little difficult for about a
week but then it's pretty much smooth sailing with minor urges.

You'll likely end up creating other habits in the process and afterwards
because at the end of the day smoking was a habit to you. Try to pick a less
destructive habit this time!

------
tsotha
>The new report rightly calls for more vigorous tobacco-control efforts,
including an increase in cigarette taxes to drive up the average price of
cigarettes to at least $10 a pack...

Will that really work? My suspicion is at those prices you're going to see a
hell of a lot of smuggling.

------
Zigurd
There is a surprising amount of prudishness about naturally occurring and
long-used psychoactive substances here. Once the harm from some traditional
ways of ingesting them are ameliorated, the prudishness is irrational. What if
nicotine is "better" than caffeine, which I'd wager most readers here have
ingested this morning, at boosting cognitive function?

If nicotine, or cannabis, or whatever isn't seen rationally, it will be left
to some packaging genius to create the equivalent of a Nepresso pod for vaping
it, or consuming it in whatever way is convenient and stylish. That seems
weak-minded for a crowd that pats themselves on the back for rationality.

~~~
contingencies
Agreed. I recently quit smoking, it sucked.

Nicotine gum was how I kept the ability to work. Nontrivial abstract reasoning
such as most programming is impossible when you are having nicotine
withdrawls. If people want to try nicotine, buy some gum.

Honestly, as far as stimulants go, I've probably tried a serious amount of
what's out there from the natural (chewed coca leaves, betel nuts, chewing
tobacco, raw tobacco, ephedrine, etc.) to legal and less legal drugs that
shall not be enumerated, and I think adequate sleep, exercise and good eating,
possibly in combination with some meditation are the lowest hassle and most
sustainable productivity enhancers.

------
r-s
Ive often wondered the same. I occasionally chew on some nicotine gum (usually
1mg, then an hour later another 1mg) as I find it helps me focus. I suspect
its better then smoking, but by how much seems fairly unknown.

~~~
MichaelGG
How on earth could chewing gum be anywhere nearly as harmful as actually
smoking tobacco-based products? Nicotine is as close to harmless as any
effective medication. So the "by how much" is as large as possible.

~~~
scott_karana
> Nicotine is as close to harmless as any effective medication

Yes, the smoking is worse than the nicotine, but how many other over-the-
counter medications have an LD50 potentially as low as 30mg/kg? That's
_insanely_ high toxicity.

Spilling nicotine on yourself causes death. That should be sobering.

~~~
hmsimha
An LD50 of 30 mg/kg means that for a roughly average 60-kg adult, a lethal
dose would be 1.8 g of pure nicotine. Were you suggesting you would have to
bring a vat of it to scalding temperatures and pour it over yourself to kill
yourself with it?

~~~
hmsimha
Out of interest in the topic, I had to look into this further. It appears the
current _oral_ LD50 in humans for nicotine is assumed to be 6.5-13 mg/kg
(perhaps even as low as 1 mg/kg in children). Nicotine is also said to be very
readily absorbed through the skin. There is one[1] case I could find
documented, from a 1933 publication of the British Medical Journal, of a
patient nearly dying from spilling two 'drachms' (or roughly 1.5 tsp) of 95%
nicotine on her arm.

I'd say there's not enough information to be conclusive, but it's _possible_
that nicotine could be lethal in doses absorbed through skin contact, though
this seems unlikely to me given practical concentrations of nicotine
solutions, and higher concentrations should be handled in a lab with proper
safety equipment anyway. Ideally, pure nicotine would be labelled as the
dangerous drug that it is, just as dangerous household cleaners are.

[1]
[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2368002/pdf/brme...](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2368002/pdf/brmedj07321-0034d.pdf)

------
Joona
So why is no country banning smoking? If the current smokers are a problem,
maybe you could give out "smoking licenses"... (Yes, I hate it.)

~~~
pmr_
Where I live (Europe) tax income through cigarette sales is substantive. Some
countries even have refrained from further increasing taxes or lowered the
planned increases on cigarettes because the last raises have caused a drop in
tax income.

I imagine prohibiting cigarettes would lead to a huge outcry on all sides of
the political spectrum fueled by lobbyist decrying the end of the free world.
There also would be a large economic impact on all the retailers, logistics
companies, promoters, distributors, and addiction management industries
(nicotine patches, e-cigarettes, and what not). By "large impact" I mean that
they would be gone for good. I guess this would still mean a net win for
society and health care costs at large, but those measures are always hard to
justify and not a very popular decision to make. That's why politicians tend
to refrain from making them.

------
anon1385
>The report newly identifies exposure to secondhand smoke as a cause of
strokes.

How long do we have to wait till the tobacco industry funded Cato Institute
finds some shills to wheel out to deny this?

And how long do we have to wait for them to apologise for decades of spreading
FUD and undermining the science that demonstrated the risks of smoking.

