Smokers—what should we do with them?

We sometimes treat them like second-class citizens. Or do we? Certainly smokers hate it when we force them out into the cold for a butt. Here in Michigan, we’re thinking about restricting smoking in a lot of public places. There benefits are supposed to accrue to three groups: the smokers themselves, their co-workers who are exposed to second-hand smoke, and the public, who pays more for health care because of smoking.

I asked a simplistic question once about whether smokers should pay higher insurance premiums, that doesn’t really bring the same benefits to everyone as a more comprehensive approach. Now, outlawing smoking altogether seems foolish—you know, prohibition, black market, etc. But is it unreasonable to limit smoking to, essentially, the someones own private space?

How do we justify a potential limitation of individual liberties? Smoking is the biggest cause of premature (and preventable) death in the U.S., leading to about half-a-million deaths yearly. Data from 1998 showed smoking was responsible for about 76 billion dollars in health care expenditures, plus productivity loses of about 92 billion dollars per year. Smoking sickens and kills people, and costs are (very crappy) economy a lot of money. For both economic and public health reasons, we must make smoking cessation a paramount societal goal.

How do we do this?


I certainly don’t have all the answers (but evidence does exist), but any national health care reform must include smoking cessation as a main priority.

Eliminating smoking in public places has no negatives, and a great potential for good. It will reduce smoke exposure to the “innocent”, and will likely encourage smokers to cut back or quit, if only for economic reasons. Taxing tobacco is another strategy, and evidence does show that people will cut back to save money, but it is a regressive tax, as lower income Americans do more of the smoking. Of course, it’s also possible that smokers are lower income because of their smoking—they spend money on cigarettes, they don’t have access to higher paid jobs where smoking is not usually allowed.

But limiting available venues for smoking is an important strategy. If we are going to get serious about helping people quit, we are going to have to support cessation programs—medications, support groups, etc. This will ultimately save us money (er, and lives).

Smokers cost us a lot of money. It may be fair to charge them more for health care (or not), but it would be more responsible to help them quit. But we are very well justified in taking a bite out of their liberties in limiting where they can smoke, as their behavior always affects others.

Comments

  1. #1 LanceR, JSG
    December 2, 2008

    How about more support for those of us who *are* trying to quit? It is pulling teeth to get insurance companies to pay for smoking cessation products, even when it would save them money in the long term, and it is nearly impossible to afford these products without insurance.

    I am currently taking bupropion to quit. I am fortunate that my prescription plan will cover this drug, as the drugs are @$400/month. My doctor wanted to try me on the new Chantix, but that is just outrageous, and my insurance won’t cover it.

    When we get serious about smoking cessation, one large part of the solution will have to be insurance coverage. Of course, a single-payer system would be simpler… IMNSHO

  2. #2 --bill
    December 2, 2008

    How, exactly, is smoking a `liberty’?

  3. #3 Denice Walter
    December 2, 2008

    Paradoxically,laws prohibiting smoking in Atlantic City casinos have been rescinded in NJ *because* of the economic crisis. I believe that the measure is temporary and hope it is not a harbinger of increasing tolerance of smoking to stimulate business: I can see restaurant and bar owners using it as an example to reverse laws that they believe are hurting their own profits.

  4. #4 Paul Murray
    December 2, 2008

    It’s antisocial, it smells, it’s offensive. Smokers should be (and increasingly are) treated much like we would treat someone who urinates on the curtains.

    But as for what to do about it – tobacco should be made a controlled substance and banned – no ifs or buts. It’s a dangerous, addictive substance. Unlike alcohol or cannabis, you can’t easily produce it at home, so many of the problems with prohibition don’t apply. Nicotine patches/gum ought be available on prescription, to manage addiction.

    Ban it outright.

  5. #5 PalMD
    December 2, 2008

    i agree that smoking cessation should be subsidized, as i wrote.

    However,

    Cost of 1 pack per day habit is about $130.00/month, cost of chantix is about $120.00/month.

  6. #6 D. C. Sessions
    December 2, 2008

    I can see restaurant and bar owners using it as an example to reverse laws that they believe are hurting their own profits.

    Total and complete BS. We got that story from bar owners in Tempe before they passed their anti-smoking ordinance a few years ago (since then Arizona has gone 100% smoke-free.) Great doom and gloom was predicted, especially for bars near the edge of town adjoining cities that allowed smoking in bars.

    It didn’t happen.

    In fact, failures of bars were the same as the year before and according to some unofficial reports, the bars adjoining cities that allowed smoking actually gained business after they went smoke-free.

    That little experience was a serious contributor to the success of the later initiative to ban smoking in public accommodations statewide.

  7. #7 Tina Kubala
    December 2, 2008

    You have hit on one of the few major social/political issues I have changed my viewpoint on. Congrats.

    I used to think smoking was a personal freedom thing. What changed my mind was moving to a state with one of the highest smoking rates in the nation. Her in rural Missouri, most everyone smokes. We have no laws keeping restaurants smoke free.

    I worked for an OB/GYN doctor when I first got here. It was so gross how many of the pregnant woman had no problem with smoking with their babies sharing that junk. We mostly had low income patients on Medicade. These kids have enough disadvantages without living in a smoker and then with a smoker.

    I also have a problem with the “personal space” thing. I live in an apartment. My next door neighbor shares a wall with us. My apartment reeks of cigarettes. I have developed a chronic cough as a direct result. I have no options. I can’t afford to move right now. I would have never lived with a smoker by choice, but the choice has been taken from me.

    I don’t have an answer. Just a perspective.

  8. #8 Brian D
    December 2, 2008

    I was under the impression that, even to a diehard libertarian, my liberties end where yours begin, and that life is one of the universal liberties. Thus, given secondhand smoke, smoking in any area where nonvoluntary exposure occurs cannot be considered a liberty even by extremist definitions, as it increases the risk to others’ right to life. (This is probably one of the reasons why the tobacco denial machine focused on secondhand smoke so heavily after the first wave of ‘smoking is bad for you’ hearings.)

    I agree with Paul Murray myself, even as I’m a bit more skeptical about the effectiveness of a ban due to the black market (I’m concerned about smuggling in particular — even though a total ban would effectively limit it to private places anyway).

  9. #9 JD
    December 2, 2008

    What happened to allowing businesses to decide for themselves? If a bar wants to allow smoking, you’re certainly free to not go there. I don’t even understand how someone could derisively type something like “We have no laws keeping restaurants smoke free” with a straight face.

  10. #10 PalMD
    December 2, 2008

    ’round here, you take what jobs you can get, if any. I have plenty of patients with asthma, heart disease, etc., who are forced to either work in a very smokey environment or not at all.

  11. #11 george.wiman
    December 2, 2008

    Ahh, the all-powerful, all-solving ‘free market’. Maybe we should apply it to all our problems and everything would be great.

    In our community bar owners predicted the end of the world, but it didn’t happen here either. And now that I can go to any restaurant in town and enjoy a meal, I eat out more. Probably die of obesity as a result.

  12. #12 davidp
    December 2, 2008

    One of the benifits of the smoking bans here is that at last my wife and I can go to live music performances – she’s asthmatic and really struggled in the smoky environment, I hated it.

    The problem with charging smokers more for health cover is the compliance and fraud issue. Our term life insurance copes with that, but health cover involves so many much smaller claims, and term life insurance is much more optional.

  13. #13 Stephanie Z
    December 2, 2008

    Minnesota is one of the only states where smoking has declined. There are survey results here on some of the factors that have motivated and helped people to quit. The fact that our tobacco company settlement funded free assistance in quitting seems to have made quite a difference, as have local smoking bans and a large one-time increase in the cost of cigarettes.

  14. #14 LanceR, JSG
    December 2, 2008

    cost of chantix is about $120.00/month.

    Where do you shop? I was quoted that *per week*.

    The other big issue with smoking cessation: I run out of my pills unexpectedly, I have to come up with the $120/month, or the $75 for gum/patches, etc. If I need a pack of smokes, it’s three bucks. I know, short sighted, but that’s the life of an addict.

  15. #15 widgitl
    December 2, 2008

    Blogs like this are so disheartening. What shall we do with these smokers? I can’t but help feeling you truly miss the point. Why should anything BE done. Travelling down this road is very dangerous. If smokers can be “dealt with” than why not fat people, or the ugly, the poor, the intellectually inferior…. I know people who are smokers that are certainly as you describe, lower socioeconomic, less educated but I also know the others who are college educated with good incomes and appear to me to be very rational people. I think it is more important to discuss why it is that people continue to smoke despite the obvious benefits to quitting.

  16. #16 Dan R.
    December 2, 2008

    Ahh… accusations without evidence. As a former smoker I don’t feel strongly one way or another, but I would hate to inject facts into a diatribe.

    Who do you think is paying the 400 billion to the states from tobacco companies — smokers. In addition, cigarettes already carry very high taxes. In many cases smokers have paid for their healthcare, especially considering…

    Smokers cost less in per capitia lifetime health expenditures because they die earlier and from more aggressive (thus less expensive) diseases. Lung cancer and heart disease tend to kill you — Alzheimer’s tends to run up huge costs in comparison.

    Citation: van Baal PHM, Polder JJ, de Wit GA, Hoogenveen RT, Feenstra TL, et al. (2008) Lifetime Medical Costs of Obesity: Prevention No Cure for Increasing Health Expenditure. PLoS Med 5(2): e29 doi:10.1371/journal.pmed.0050029

  17. #17 widgitl
    December 2, 2008

    I’m also from minnesota. I understood that very little of that money that was allocated to minnesota from The Great Tobacco Settlement actually went to helping smokers to quit. Some did go to an advertising campaign designed to portray smokers as 21st century equivalent of the old testament leper. Minnesota like most of the other states in that settlement used that money to fix its budget following the downturn in the economy post Sept 11,2001. In return for that money, the states had to agree not to raise taxes on cigs. nice compromise, huh!

  18. #18 Chad
    December 2, 2008

    Banning smoking entirely is, for a lack of a better word, retarded, but I’m really not sure where I stand on this issue. The personal freedoms issues cuts both ways, and since I’ve lived in Michigan and Chicago recently I’ve seen the lax and the strict. Not quite sure which I prefer quite yet (I smoke when I drink and it’s very cold most of the year in the upper midwest, so it is a bit of a conflict of interest).

  19. #19 Chad
    December 2, 2008

    Dan, I totally forgot about that paper. I read it when it first came out and was surprised there wasn’t much media attention about it. Have to give it another read to make sure everything in the paper makes sense though…

  20. #20 Anonymous
    December 2, 2008

    Maybe a clever scientist will bio engineer something that kills tobacco plants and renders them extinct. Ok now I have a twisted idea for as scifi novel.

  21. #21 huf
    December 3, 2008

    They’ve been trying the overtaxation here too, but it only made smuggled cigarettes more prevalent (which have *zero* supervision, they could’ve been grown in Chernobyl for all we know).
    I really don’t see how my smoking inconveniences anyone. Just as i wont stand under my neighbor’s window at 2AM and scream obscenities, i wont stand in his face and blow smoke at him. Not because smoking kills, but because it’s common courtesy.
    But if someone visits me and complains about smoke, tough luck.
    Smokers pay more taxes, live shorter lives, so it’s a win-win for everyone.
    Why the campaign against smoking? Because it’s unhealthy? Are we so committed to health that we wont allow a harmful hobby? (and yes, smoking is a hobby; unlike a lot of smokers, i actually *like* smoking, and am not trying to quit)

  22. #22 Andrew Dodds
    December 3, 2008

    Smokers contribute more in tax and take less in the way of healthcare and pensions. And smoking is optional..

    As long as you mandate decent ventillation in bars where smoking is allowed, I don’t see what else you need, apart from strong and obvious warnings about the dangers.

    The cost of anti-smoking stuff seems high.. but I was only on it for 3-4 months, after that it’s all savings.

  23. #23 Armchair Dissident
    December 3, 2008

    Of course, it’s also possible that smokers are lower income because of their smoking—they spend money on cigarettes, they don’t have access to higher paid jobs where smoking is not usually allowed.

    I don’t know what you’re smoking (pun intended), but this is appaling logic! Are seriously trying to suggest that smokers are on lower incomes because they smoke, and the reason for this is that they spend money on cigarettes, and therefore can’t get better jobs?

    Since when has someones spending habits determined how much money they can earn?

  24. #24 Ricahrd Eis
    December 3, 2008

    You need to prevent people from starting smoking in the first place. Especially the under-aged.

    The longer someone goes before trying smoking, the less likely they are to suffer addiction and become a long term user.

    You can squeeze the older half of the smoking population down with medical help and advice, but they and those that die are still being replaced by the next generation who think it’s cool/what adults do.

  25. #25 eleanora.
    December 3, 2008

    You don’t have the freedom to punch someone in the throat, so why should you have the freedom to inflict an asthma attack on them? Huf, it is not just not blowing smoke in someone’s face, but the fact that if they are in the same area as you (public transport, cinema, restaurant) the smoke circulates and then they are forced to either breathe your smoke or leave. That effectively meant that I could not go to places and do normal things I wanted to.

    In Aus smoking has been banned in most enclosed public places for years. Bars and pubs were the most recent, with smoking there being banned a year or two ago. There was resistance, with claims that it would hurt business, but business in fact increased slightly.

    I liked the comment about urinating on the curtains, above. It is certainly anti social, but unlike smoking, it doesn’t harm anyone.

    I don’t think I have ever heard anyone claim that nicotine patches or other drugs to help you quit are too expensive. OTOH I live in Aus where many drugs are government subsidised, and the taxes on cigarettes are high. Last time I noticed, most packs were $AU12-15. (Yes that’s packs, not cartons.)

  26. #26 MH
    December 3, 2008

    Pictures of diseased lungs on packets of cigarettes.

    I stopped smoking about five weeks ago; I decided I didn’t want cigs to be in my future. Here in the UK, such pics on packets are due to appear soon. I personally think they would have made stopping easier for me (though admittedly, I didn’t find it that hard due to the excellent book, “How to Stop Smoking”, by Allen Carr).

    Not only would such memento mori help people decide to stop smoking, I think it would also put kids off starting.

  27. #27 MH
    December 3, 2008

    Correction: that should be “The Easy Way to Stop Smoking”.

    Btw, vilifying smokers will only make many of them more resistant to change, though admittedly, it may make the Carrie Nations doing the vilifying feel nice and virtuous, which is perhaps the reason why their condemnation is so vociferous. There are many more constructive avenues to explore.

  28. #28 Dunc
    December 3, 2008

    Here in Michigan, we’re thinking about restricting smoking in a lot of public places.

    If you mean enclosed public places, I’ve no problem with that. If you mean in the open air, I have to point to vehicle pollution.

    Unlike alcohol or cannabis, you can’t easily produce it at home

    Tobacco is very easily grown, and curing it properly is no more difficult that home brewing.

    You don’t have the freedom to punch someone in the throat, so why should you have the freedom to inflict an asthma attack on them?

    Excellent. Can we please have a law to ban the use of excessive amounts of perfumed cosmetics too? I occasionally find myself gagging and choking because of other people’s rank aftershave, and I have a friend who could go into anaphylactic shock…

  29. #29 Doug
    December 3, 2008

    Perhaps someone can clear up a bit of confusion for an ignorant Brit. Are US health insurance premiums a flat rate? If so I’m slightly surprised that the free market didn’t sort that one out.

  30. #30 Scott
    December 3, 2008

    Speaking as someone 603 days quit…(or day 1 for the 603rd time)…

    Chantix works great, if you can handle the side effects. LanceR, JSG – Chantix can cost about $130 per month. Whoever told you it cost that per week is either wrong or trying to rip you off. And many insurance companies are now covering it.

    I could not have quit without it.

  31. #31 Brian
    December 3, 2008

    1) As to the coverage of smoking cessation aids: I’ve been told by my insurance company that smoking cessation materials are specifically not covered by my school’s insurance, because beginning smoking was a choice. Why do we consider birth control pills practically a god-given right, but smoking cessation a “choice”-mitigating “luxury”? Last time I checked, no one forced me to have sex, so how is that any less of a choice? Yes, I get that BCP are not prescribed exclusively for this purpose, but I speculate it constitutes a healthy majority, nonetheless.
    And while it is true that pills vs. cigarettes is a push, cost-wise, as Pal noted, paying it a little bit at a time for cigarettes is a far more attractive option, especially for those receiving a weekly paycheck.
    2) Not actually a supporting argument, but more out of morbid curiosity: Is anti-smoking legislation/taxation substantially different than, say, anti-obesity legislation or taxation? I ask as a former EMT; though I can’t find a primary source on short notice, my Mosby paramedic text, as well as several other sources of EMS information, report that back injuries are a major problem for EMS workers. Though patient transport technology is constantly improving, there is still considerable risk for providers, especially in those all-too-common cases involving the transport of morbidly obese patients down two narrow flights of stairs. So anti-obesity efforts benefit not just the obese, but their caregivers as well; why haven’t we seen more done in this department?
    3)Doug, the free market isn’t applicable here. Some things just ain’t free markets.

  32. #32 BobbyEarle
    December 3, 2008

    Paul Murray opines…

    Smokers should be (and increasingly are) treated much like we would treat someone who urinates on the curtains.

    Really?

    As a smoker, I understand that my smoking is bothersome to non-smokers. That is why I have never lit up in a cinema, grocery (or other) store, in a restaurant..even when allowed. Most smokers are very respectful, and will not knowingly infringe on others right to be smoke free.

    I will always ask first before I pee on your curtains, Paul.

    Oh, and BTW…bite me.

  33. #33 Ramel
    December 3, 2008

    I quit smoking nearly 3 years ago after a really bad chest infection, for about 10 days I just couldn’t face even the thought of a cigarette and when I got better the worst of the cravings was over so I decided to stick with it. My experience with patches and gum was that they just prolonged the misery.

  34. #34 Nemo
    December 3, 2008

    Most smokers are very respectful, and will not knowingly infringe on others right to be smoke free.

    Man, what world do you live in?

  35. #35 Teresa
    December 3, 2008

    Ramel,

    I had three reasons to quit smoking: I was going to have kids, I was done with school and a lot of stress had gone away from my life with that: and I loved doing martial arts and exercising…and as I got older, I could tell that smoking would eventually make me unable to do such things.

    The final straw, though, was the really bad chest infection that lasted a couple of weeks.

    I totally get what youare saying. Congratulations, and I sympathize. :-)

    My proposal for helping people quit: Iron bands around the chest, cutting effective lung capacity in half for about two week…making air with normal oxygen content a precious, precious commodity. :-)

  36. #36 Teresa
    December 3, 2008

    Nemo,

    Most of the smokers I know personally are extremely aware and considerate, and would never dream of infringing on non-smokers intentionally.

    However, I understand your skepticism, because I also worked in the service sector while in college, and had to deal with plenty of belligerant and violent people who physically threatened me for suggesting that they stick to the smoking area with their cigarettes.

    For the record, I suspect that they actally ARE the same people who would pee on the curtains. I certainly suspect that they are the same statistical minority that managed to poop on the toilet rings in the restroom.

  37. #37 CyberLizard
    December 3, 2008

    @Brian – “Is anti-smoking legislation/taxation substantially different than, say, anti-obesity legislation or taxation?”

    I think the big difference is that we all need to eat. It’s just a matter what we choose to eat. And it’s not just about what we eat, it’s about what level of physical activity we have and other considerations. However, we don’t need to smoke. It is purely a choice.

    And as far as those who say that designated smoking areas or proper ventilation can mitigate the problem; you just don’t get it. Smoke circulates in the air. Unless you enclose the smoker’s head in an acrylic sphere and duct the smoke somewhere else, it will circulate. I realise that I’m probably in the minority in that I am extremely allergic to smoke and so affected much more by this issue than the average person, but the fact is that smokers are directly and measurably affecting the health of everyone around them. I am all in favor of eliminating smoking in all public places.

  38. #38 Sigmund
    December 3, 2008

    Rather than pictures of lung cancer why not make the tobacco companies attach a days supply of nicotine gum to each packet. Replacing the nicotine I was getting from smoking was the key to ending my addiction to cigarettes a decade ago.

  39. #39 bob
    December 3, 2008

    Interesting, we have concern trolls sliding down slippery slopes and libertarians comparing smoking in public to wearing too much perfume. This comment thread can only get better. [Munches popcorn.]

  40. #40 Skeptico
    December 3, 2008

    Paul Murray:


    But as for what to do about it – tobacco should be made a controlled substance and banned – no ifs or buts.

    Sure. It worked so well for alcohol. And its working so well for other drugs.

  41. #41 Grimalkin
    December 3, 2008

    To all the smokers who say that they are respectful when they smoke – where are you people? In my entire life, I have been asked ONCE by a smoker if it was alright for him to light up. The vast majority of the time, smokers will just stand right next to me and start smoking. The fact that I have never seen a single person on the internet saying “meh, I don’t care, I just light up wherever” suggests to me that either a lot of you are lying, or rude smokers don’t know how to use the internet. I wonder which is more likely?

    Like someone who posted above, I live in an apartment and it always reeks of smoke (both cigarette and marijuana). The fact is that an apartment building doesn’t separate smells all that well. Smoke just comes in from the vents, from other open windows, or from under the door. I’m left without a choice – I can’t afford a house and anywhere I rent is just going to be the same. So I am forced to wallow in smoker’s filth. If we’re talking about fairness, how is this fair to me? How is it fair that I have to struggle with a bad cough all the time even though I have never smoked in my life?

    Also, people who smoke while walking down the street. What am I supposed to do? I have to walk too, and I can’t always overtake them to walk ahead. So I’m stuck, sometimes for half an hour or more, walking behind a chain-smoker and getting it all blown right in my face. Or when I wait for the bus and smokers ignore the sign that says that they have to stand at least 15 meters away. Or when I try to go in or come out of a building and smokers are just standing all around the doorway. What am I supposed to do?

    If the situation allows, I’ll usually ask smokers if they could move. I do this nicely. Some apologize and move, but many get very rude. So again, what am I supposed to do?

    Your rights end when they infringe on mine. The fact is that smoking is not a personal choice – it affects everyone nearby.

  42. #42 Grimalkin
    December 3, 2008

    By the way, someone compared anti-smoking legislation to obesity legislation. These are two completely different things. When you eat a cheeseburger, it doesn’t end up in my stomach. So yes, the health care costs go up, but at least it won’t be making ME fat.

  43. #43 Barn Owl
    December 3, 2008

    If cigarette smoke is so wonderful and harmless, why do smokers hold their burning cigarettes out the window at arm’s length, while stopped in traffic?

    I suggest that you, smoker, roll up your window and turn your vehicle into a pleasant smoke-filled carcinogenic haven. No, really, please.

  44. #44 ianimaru
    December 3, 2008

    just drop my opinion, i’m smoker and agree with #1 comment, we need support for trying to quit

  45. #45 3.14159
    December 3, 2008

    Where are all the respectful smokers? That’s easy, they’re not smoking around you, so you don’t know they’re smokers. I get that a lot, being a respectful smoker. People who’ve known me for quite a while will be surprised to find out I’m a cigarette junkie.

    I do support public smoking bans, but one of the interesting side effects I’ve noticed is that it creates what is effectively a smoking support group. When you spend 20 minutes a day or so with the same people all doing the same thing, what you end up with is a group of people who support your habit. I think it evens out in places where it gets cold, but I could see it making it somewhat more difficult to quit if I lived somewhere where it was warm year round.

    There needs to be more support for people who are quitting. Just like with drug addiction, it’s very easy to just push people out of society and forget about them, but it doesn’t solve the problem. You need to make it harder for people to smoke and easier for people to quit, if you just make it harder for people to smoke, the addiction will simply push people into more creative ways of getting a fix. The negatives need to be packed up with a positive, simple, functional path to freedom from addiction.

  46. #46 DPSisler
    December 3, 2008

    I am an asthmatic. Without my pills, I would be hospitalized within days. When I walk by someone in the streeet, or sit besides someone who is smoking in a restaurant, I have always wanted to continually fart in their face. Isn’t it the same concept – subjecting others to offensive smells? At least farting will not kill the other person.

  47. #47 Riman Butterbur
    December 3, 2008

    And as far as those who say that designated smoking areas or proper ventilation can mitigate the problem; you just don’t get it. Smoke circulates in the air.

    I’m sure most smokers think they are “good people” but many don’t seem to be aware of how pervasive smoke is.

    I am extremely allergic to smoke and so affected much more by this issue than the average person, but the fact is that smokers are directly and measurably affecting the health of everyone around them.

    Many are also allergic to perfumes, and other things. And you don’t have to be allergic. some things are just naturally harmful.

    we don’t need to smoke. It is purely a choice.

    Not a choice for an addict. It’s like sex: once a child starts, they won’t stop. You have to catch them young — very young.

    Posted by: CyberLizard [TypeKey Profile Page] | December 3, 2008 15:10 UT

  48. #48 LanceR, JSG
    December 3, 2008

    It sure is good to see such supportive comments from the nonsmoking segment of our little community. I don’t think I’ve seen such an outpouring of compassion since the last time Fred Phelps brought his clan to town. Amazing.
    </sarcasm>

  49. #49 Ramel
    December 3, 2008

    I depresses me alot seeing these insults being thrown at smokers, it promotes a seige mentality in smokers and reinforces a sense of “Us and Them” that gets tied up in the reasons people keep smoking, if you put excessive pressure on people they will resist and become extremly stubborn. It’s also just plain rude.

  50. #50 khan
    December 3, 2008

    Unless you enclose the smoker’s head in an acrylic sphere and duct the smoke somewhere else, it will circulate.

    MAD Magazine ‘invented’ just such a device in the ’60s.

  51. #51 CyberLizard
    December 3, 2008

    I don’t see insults being thrown at smokers. What I see are people reacting to the actions that smokers are taking that affect others health. There is absolutely no denying the fact that smoking is damaging, both to the smoker and to those around them. I couldn’t care less if you engage in a self-destructive manner (except for feeling compassion), but when you affect my health or my children’s health, that’s where I draw the line.

    For what it’s worth, I also think that more needs to be done to assist those who want to quit. It’s got to totally suck, being addicted to something. But I’m not going to accept your addiction as an excuse to allow you to keep damaging my lungs.

    As far as being “rude” to smokers by pointing out the fact that what they are doing is adversely affecting, not only their health, but the health of the public at large, including by affecting health care costs and other ancillary results, well, tough titties. I think it’s “rude” to try to kill me (yes, this is hyperbolic).

    Dammit, you’ve hit my trigger issue. Sorry for the rant.

  52. #52 CyberLizard
    December 3, 2008

    @kahn – I was wondering if anyone else would pick up that reference LOL

  53. #53 Ramel
    December 3, 2008

    *sigh*
    My point is that smoking is bad. People should be encouraged to stop smoking. Ranting at them like a complete arse is counter productive because it increases resistance to the idea of quitting. The last comment about being rude was half joking about the people who rant about smoking being rude. Whatever your opinion on smoking or any other topic you should at least try to be civil.

  54. #54 Anonymous
    December 3, 2008

    We rant because we care ;-)

    I completely agree that we should encourage people to stop smoking (my lungs would certainly appreciate it). And I haven’t seen anything uncivil in this thread, except for maybe one comment at the beginning who likened smokers to someone who urinates on curtains. And that was just funny. Most of the discussion has been about people recounting their actual experiences, both with dealing with smokers and being a smoker. Sounds like a good discussion to have.

  55. #55 CyberLizard
    December 3, 2008

    Something wonky with the TypeKey sign in thing. That last comment at 3:25 wasn’t meant to be Anonymous.

  56. #56 Neil
    December 3, 2008

    Okay, for the record, both ardent smokers and ardent anti-smokers can be jerks. Comparing smoking in public to urinating all over someone’s living room is both overly simplistic and deliberately insulting. At the same time, if you don’t know at least one smoker who will ignore your requests to not smoke around you, you probably don’t know very many smokers. No ideology or practice will ever be free of jerks.

    That said, it is perfectly reasonable to ban smoking in public places, even businesses, provided that some accommodation for smokers is made (if you don’t, they won’t wait until they are home to smoke, they will just smoke in public anyway). Smoking is harmful, and regardless of data on secondhand smoke, if there were just a credible risk to bystanders, that would be enough to take precautions on their behalf.

    Banning smoking outright, though, is a terrible idea. First of all, it is an infringement of personal liberties. You have the right to choose your own lifestyle just as you have the right to hold an opinion, so long as these lifestyles or opinions do not spill over into violence, property damage, etc. Second, even if things are bad for people, banning them does not work. Alcohol has been linked to over a third of violent crime, it is also responsible for thousands of American deaths each year. I don’t think I need to elaborate on the failures of prohibition in this case.

  57. #57 strech
    December 3, 2008

    @CyberLizard:
    Well, as pointed out, perfumes can set off asthmatics as well. Practically everything could set off, say, Bubble Boy, but that doesn’t mean we base laws for everyone else around him. It’s clearly both reasonable and desirable for the government to ban smoking in government-run enclosed areas. I haven’t checked the research on open areas recently so I don’t know how harmful second hand smoke is in non-enclosed areas, but if the answer is “Not to anyone but asthmatics”, then I don’t think it’s necessary or desirable for the government to ban smoking in such areas unless it’s essential services (e.g. around courts, etc). If you have some studies on the effect of second hand smoke in non-enclosed areas, let me know.

    Private areas aren’t the governments business at all unless given a compelling reason. Smoking-related Healthcare costs are not such a reason, especially as since smoking has such clear-cut externalities an appropriate smoking tax is both necessary and sufficient, although vulnerable to abuse in the too-high direction. Of course, the moralizers will never stop there; witness the U.K., where the smoking tax brings in vastly more than smokers cost the system, but David Cameron wants to move beyond simply taking smoking into account where it affects health care outcomes (reasonable) to banning smokers from some routine treatments.

    Working conditions is a much more reasonable basis for legislation targeted at public places, but I still think it’s overreaching. And of course, the idea that people don’t care what other people do with their lives is belied by measures banning smoking in all apartment complexes. (Grimalkin: Yes, you can find find better apartment complexes. No, no apartment or situation will be “perfect” but that’s not an excuse for criminalizing behavior). People have the freedom to annoy and irritate you, just not harm you; it shouldn’t magically become illegal because the irritating person is an easy target for vilification.

  58. #58 The Perky Skeptic
    December 3, 2008

    Er… as someone prone to get headaches from strong smells, I’m all for Excessive Perfume bans, too. :) But then, if I ruled the world, smoking-cessation products would be subsidized and all perfumes would be BPAL.

  59. #59 CyberLizard
    December 3, 2008

    @strech – we’re not talking about just asthmatics here. Smoke damages even healthy lungs.

    I disagree with you about not banning smoking in non-governmental buildings. I think that both the public health risk as well as the health care costs are both compelling reasons to enact such bans.

    I, personally, have never heard of entire apartment complexes that have banned smoking, although given the nature of the structures and the close quarters of the residents, it’s probably a good business decision if complexes offer such amenities. Many hotels have gone that direction. But I wouldn’t suggest that legislation mandate it.

    However, I do have a serious problem with people who smoke in their homes or cars around their children. It’s not acceptable to destroy the health of a child who has no choice in the matter. It is incomprehensible to me that a parent who otherwise proclaims to love their child would display such a blatant disregard for that child’s health and well being.

    Absolutely people have the freedom to annoy and irritate me. I have been known to annoy and irritate people myself. But we’re talking about physically harming someone else, and no one has that right.

  60. #60 D. C. Sessions
    December 3, 2008

    Trying to get some consensus here; the question was, “Smokers — what should we do with them?”

    I observe that there have been no votes for standing them up against a wall and giving them a blindfold and a last cigarette.

  61. #61 Tulse
    December 3, 2008

    it is perfectly reasonable to ban smoking in public places, even businesses, provided that some accommodation for smokers is made (if you don’t, they won’t wait until they are home to smoke, they will just smoke in public anyway).

    Why won’t they wait? Isn’t smoking a choice? Surely they don’t need to smoke in public, right?

    There is nothing sadder than addicts trying to rationalize their addiction.

  62. #62 CyberLizard
    December 3, 2008

    Trying to get some consensus here; the question was, “Smokers — what should we do with them?”

    I observe that there have been no votes for standing them up against a wall and giving them a blindfold and a last cigarette.

    LOL! Thanks for pulling us back on task. Sorry, I was getting my rant on :D

  63. #63 Gingerbaker
    December 3, 2008

    “Smoking is harmful, and regardless of data on secondhand smoke, if there were just a credible risk to bystanders, that would be enough to take precautions on their behalf.”

    Just how credible is the risk?

    Has the EPA published any reports showing a statistically significant increase in heart attack or lung cancer caused by second-hand smoke?

    Was not the WHO accused of quashing an actual case-controlled study which showed no actual increase of cancer risk in nonsmokers who worked around smokers or who had spouses who smoked? In fact, did not the study show a 22% decrease in lung cancer risk among the children whose parents smoked?

    Does anyone here have a solid understanding of the foundational studies used to justify public smoking bans, and whether they actually represent good science?

  64. #64 strech
    December 3, 2008

    Cyberlizard:

    On the apartment thing, I was referring to laws like this, where cities are banning smoking in all apartment buildings. The story mentions something like “second hand smoke invading other apartments” but as best as I can tell, the actual law just needs any smoking and a complaint.

    And yes, I know second hand smoke harms everyone, at least in enclosed areas (thus the support for banning smoking inside government-run buildings); the part I’m not sure about (as I haven’t seen the studies; link to me if you have them) is second-hand smoke in open-air areas.

    The reason healthcare costs aren’t a reason for smoking bans is that cigarette taxes already more than cover the healthcare costs without limiting freedom. The best figures I could find were in Great Britain, where the taxes brought in 9 billion pounds, but smokers cost 1.4-1.7 billion pounds. So given that smokers bring in more extra money than they cost in healthcare – by more than 7 billion dollars, why is healthcare cost a reason for further regulation?

    As for “public health” can you clarify what you mean?

  65. #65 CyberLizard
    December 3, 2008

    EPA info on secondhand smoke

    In early 1993, EPA released a report (Respiratory Health Effects of Passive Smoking: Lung Cancer and Other Disorders; EPA/600/6-90/006 F) that evaluated the respiratory health effects from breathing secondhand smoke (also called environmental tobacco smoke (ETS)). In that report, EPA concluded that secondhand smoke causes lung cancer in adult nonsmokers and impairs the respiratory health of children. These findings are very similar to ones made previously by the National Academy of Sciences and the U.S. Surgeon General.

    The EPA report classified secondhand smoke as a Group A carcinogen, a designation which means that there is sufficient evidence that the substance causes cancer in humans. The Group A designation has been used by EPA for only 15 other pollutants, including asbestos, radon, and benzene. Only secondhand smoke has actually been shown in studies to cause cancer at typical environmental levels. EPA estimates that approximately 3,000 American nonsmokers die each year from lung cancer caused by secondhand smoke.

    Every year, an estimated 150,000 to 300,000 children under 18 months of age get pneumonia or bronchitis from breathing secondhand tobacco smoke. Secondhand smoke is a risk factor for the development of asthma in children and worsens the condition of up to one million asthmatic children.

    EPA has clear authority to inform the public about indoor air pollution health risks and what can be done to reduce those risks. EPA has a particular responsibility to do everything possible to warn of risks to the health of children.

    A recent high profile advertising and public relations campaign by the tobacco industry may confuse the American public about the risks of secondhand smoke. EPA believes it’s time to set the record straight about an indisputable fact: secondhand smoke is a real and preventable health risk.

    EPA absolutely stands by its scientific and well documented report. The report was the subject of an extensive open review both by the public and by EPA’s Science Advisory Board (SAB), a panel of independent scientific experts. Virtually every one of the arguments about lung cancer advanced by the tobacco industry and its consultants was addressed by the SAB. The panel concurred in the methodology and unanimously endorsed the conclusions of the final report.

    The report has also been endorsed by the U.S. Department of Health and Human Services, the National Cancer Institute, the Surgeon General, and many major health organizations.

  66. #66 strech`
    December 3, 2008

    Whoops, that should be “more than 7 billion pounds”, not “more than 7 billion dollars”.

    Also, the sentence about the ban I sort of quoted should have been “whose secondhand smoke invades their neighbors’ units”. Man, there needs to be an edit button; I always miss something in preview.

  67. #67 DuWayne
    December 3, 2008

    Nemo & Grimalkin -

    I am one of those considerate smokers you never see. Why don’t you see me? Because I assume that if someone doesn’t have the tell-tale signs of being a smoker, they probably would prefer that I not light up around them and I don’t. I rarely smoke indoors (before moving back to MI it had been almost four years, even now I have been in a coffee shop that allows it twice) and I only smoke outdoors if there is no one around who is likely to be bothered, or if I am in an area marked for smokers (something not uncommon in my recent home, the people’s republic of Portland, OR).

    Not only do I work at being considerate, I also call asshole smokers on being asshole smokers. One of my biggest pet peeves was the jerks who would ask me for a light on a MAX (Portland’s light rail) platforms, where smoking is banned. Or jackasses who like to get right up to the door of a store, restaurant or bus – especially the ones who exhale that last puff inside.

    I am also very keen on quitting, the problem is that I have found zero help available in doing so. I live in pretty extreme poverty, but I also roll my own and spend on average, about ten dollars a week on tobacco. Contrast that with over a hundred dollars a month for the lowest cost smoking cessation aids and I’m pretty well fucked for getting any of them.

    Being poor means being in a pretty constant state of crisis. I don’t have the room to take it easy so I can be in a decent frame of mind to quit. On top of that, I have severe ADHD and I’m bipolar – I also have/had a partner (mother of my kids) who is also a bipolar smoker. And if we weren’t fucked enough on living in constant crisis mode, we lost our home after an injury lost me the ability to do most of the work I have been doing and just as I was getting to the place where I could work again, the market sank and most of the work I was lining up evaporated. So we had to leave the city we fell in love with to come back to the most depressed economy in the country, MI (probably not far from PalMD – Portage).

    And to top it all off, my partner has been off meds for a while now and decided Monday, while I was out taking my placement exam for community college, to pack up the baby, a few of there things and pulled our oldest out of class less than a half hour after I left. So my crazy ex has now run off with her sister and brother-in-law to TN, taking my children with her. So now, I have to file for emergency custody – only we haven’t been in MI long enough, so OR courts have jurisdiction.

    Smoking’s a fucking choice?!? The idiot mistake of starting when I was fourteen was a choice, to be sure. But now? Now I’m a fucking tobacco junkie, an addict and the circumstances are just not making quitting viable – especially as I have no options for getting any help at the moment. No smoking cessation aids, hell, I can’t even get my fucking psych meds. It’s only because caffeine helps me function in spite of the extreme ADHD and that my bipolar isn’t extreme that I can function at all.

    So for all you “well wishers” who seem so sympathetic to my plight and the plight of other smokers; Fuck You, and excuse me, I need a cigarette.

  68. #68 katie
    December 3, 2008

    @Brian,

    “Why do we consider birth control pills practically a god-given right, but smoking cessation a “choice”-mitigating “luxury”?”

    Because birth control pills are a medication that are also frequently used for other things such as treatment for severe PMS.

  69. #69 DuWayne
    December 3, 2008

    To make it absolutely clear, I have desperately wanted to stop smoking for years. A desire that only increased when I found out I was going to be a dad. I rejoiced when the tobacco lawsuits brought down billions, thinking that I would finally have access to help in quitting. But when it all settled down and the dust cleared, I find that not one fucking dime of it was going to actually help me get anything besides fucking advice on quitting. The first bit of advice being; “don’t try to quit when you are under tremendous stress.”

    The few times I have actually gotten health insurance, none of the plans I had access to would cover smoking cessation either.

    As for smoking and UHC, I am all for making it very clearly delineated. Another tax on tobacco products. One that is legislatively mandated to defray the cost of health care for smokers. And while we’re at it, we can add such a tax to alcoholic beverages and “junk food.” The latter being rather harder to define, but not impossible by any means.

    CyberLizard -

    I am always surprised at how difficult it is in some places to get a rental that doesn’t allow smoking. When I was living in Lansing, MI, it was easy enough. And in Portland, it is actually more of a challenge to find rentals that allow smoking.

    I’ve worked for a lot of landlords over the years and none of them allowed smoking in their rentals. Two reasons. One, it really sucks to turn over a unit that has had smoking inside. From painting to getting rid of the stench, it just really sucks. But the more important reason and one that really gets the property owners, is the insurance. Insurance is substantially cheaper if you don’t allow smoking in your properties.

    Most of the smokers I know, just smoke outside. Even friends who could smoke inside choose not to, because it makes everything stink and is that much harder on the lungs. I mean why smoke it more than once? I guess it’s very much a regional thing.

  70. #70 William Miller
    December 3, 2008

    I don’t smoke and never would, but I would be opposed to attempts to limit it outside buildings – the numbers seem clear enough that secondhand smoke is a risk indoors. I would not want to ban it in private homes (any enforcement would mean WAY too much intrusion on privacy) or places like bars, nightclubs, etc. where health isn’t a concern.

    I don’t consider the risk *to the smoker* to have any relevance to anything. If you’re an adult, you have the inalienable right to risk your own life.

  71. #71 PalMD
    December 3, 2008

    …places like bars, nightclubs, etc. where health isn’t a concern.

    This is not so clear cut. Folks who work in these places might not be able to simply leave and find a new job.

  72. #72 Danimal
    December 3, 2008

    PalMD, let me say that I am a smoker, federal employee (at a major research laboratory), and business owner. I may also be called a denialist in the sense that I question the issue of harm cause by second hand smoke (SHS). I do not deny the health effects caused by active smoking. I have quit smoking 3 times in my life, twice for a year and once for three years and have always done so cold turkey. MarkH and I have butted head on the issue of SHS as can be seen here (Dan = Danimal) and he would call me a denialist. I could argue otherwise, but that would take too much of my time right now. Usually, I like your posts and even expressed that I wouldn�t mind having you as my doctor. But I take issue here.

    We sometimes treat them like second-class citizens. Or do we? Certainly smokers hate it when we force them out into the cold for a butt. Here in Michigan, we’re thinking about restricting smoking in a lot of public places. There benefits are supposed to accrue to three groups: the smokers themselves, their co-workers who are exposed to second-hand smoke, and the public, who pays more for health care because of smoking.

    Smokers are treated as second-class citizens. The anti-tobacco crowd is largely no longer anti-smoking, but has become anti-smoker (as evidenced by some of the commenter here). Smokers are being denied employment, banned acting as foster parents, not allowed to adopt, being called child abusers if they smoke in the presence of their children, denied housing, etc. (depending on where one lives). The ban on smoking in workplaces was to protect the workers. As a business owner (not in the hospitality business) and can sympathize with the business owners that are. For example, if I were a bar owner I would not consider my business a public place, but a private place. I can deny entry for any reason except for illegal ones (like race, age, etc.) If I want to cater to smokers, I should be able to put I sign up stating that the business allows smoking along with a health warning, hire only smokers (after all businesses are allowed to, in most states, not hire smokers) then the issue of worker protection goes away. Those sensitive to smoke or who do not like the smell do not have to enter. The public does not have a right to enter, I cannot entry just because I think someone is ugly, smells, does not smoke or I do not like them for any other reason.

    I also take issue with the public paying more for smokers. I would argue smokers pay more in taxes that more than offsets any perceived increase in health care cost. We live shorter lives thus costing the public less. In addition, the Master Settlement Agreement (MSA) was suppose to pay for the added costs to the states. This did not hurt the tobacco companies at all, since the costs were passed on to smokers as a kind of backdoor tax.

    I asked a simplistic question once about whether smokers should pay higher insurance premiums, that doesn’t really bring the same benefits to everyone as a more comprehensive approach. Now, outlawing smoking altogether seems foolish—you know, prohibition, black market, etc. But is it unreasonable to limit smoking to, essentially, the someones own private space?

    See my last paragraph; smokers already pay the higher costs through the MSA and higher taxes. The black and grey markets are already alive and well. Many states claim reduced smoking rates based on tax revenue, not realizing that smokers have gone to these markets. Outlawing smoking would let non-smokers know how much smokers were subsidizing them as states would have to raise taxes on everyone to make up for the budget shortfalls due to lost MSA money and taxes.

    How do we justify a potential limitation of individual liberties? Smoking is the biggest cause of premature (and preventable) death in the U.S., leading to about half-a-million deaths yearly. Data from 1998 showed smoking was responsible for about 76 billion dollars in health care expenditures, plus productivity loses of about 92 billion dollars per year. Smoking sickens and kills people, and costs are (very crappy) economy a lot of money. For both economic and public health reasons, we must make smoking cessation a paramount societal goal.

    See my previous comments. I see nothing wrong with business owners not allowing smoking on their PRIVATE property. Likewise, as a business owner I should be able to cater to just smokers and force non-smokers outside or not admit them. After all it�s my private business. The statements made with regard to lost productivity and extra costs are bullshit. The largest lose of productivity comes from having children, especially when school aged, playing trade the germs, and bring them to mommy and daddy.

    Eliminating smoking in public places has no negatives, and a great potential for good. �. as lower income Americans do more of the smoking. Of course, it’s also possible that smokers are lower income because of their smoking—they spend money on cigarettes, they don’t have access to higher paid jobs where smoking is not usually allowed.

    Eliminating smoking in public places is a good goal as long as you understand the difference between a public place and a private place. A business that I own is a private place and if the concern is for worker I can hire only smokers. Yes the largest amount of smoking is done by blue collar workers and white collar workers generally do not have a problem raising their taxes or putting the bars where they gather out of business. While I am white collar, I enjoy hanging in �red neck� bars.

    This will ultimately save us money (er, and lives).

    Bullshit. If smoking were to go away it would cost non-smokers more money in taxes due to lost MSA money and cigarette taxes and would not save a single life. No one lives forever.

    Smokers cost us a lot of money. It may be fair to charge them more for health care �

    Again bullshit, we save non-smokers money by paying the MSA and higher taxes that more then make up any perceived extra health care cost. Because smokers die earlier we actually safe money in health and social security costs. What is worse, paying for a smoker who dies quickly as a result or having someone live until a 100 with all the extra costs when they are no larger productive to society and become a burden?

    Finally I�ll add that in my largely smoking family those who died early were those that quit smoking. After they quit, they became obese, developed diabetes, and died of complications due to diabetes. The weight gain was why after 3 years not smoking I started again.

  73. #73 Barn Owl
    December 3, 2008

    Tempting as it is to be snarky, I’ll repeat my question and add “please answer”:

    If cigarette smoke is so wonderful and harmless, why do smokers hold their burning cigarettes out the vehicle window at arm’s length, while stopped in traffic?

    The weather here is mild most of the year, so almost all cigarette smokers engage in this behavior while driving.

  74. #74 DuWayne
    December 3, 2008

    I think the final straw on smoking bans for me, was moving back to MI. In Portland, I was half-heartedly opposed when the smoking ban was extended to bars. There, most bars had voluntarily banned smoking and there were a lot of places that served alcohol were already included in the restaurant ban. But honestly it really was half-hearted, because I didn’t go to such places and the doom and gloom of businesses closing turned out to apply to very few places. I would liked to have seen special licenses for establishments that wished to continue to allow smoking, but whatever. The one that bugged me the most, was that smoke shops were also included in the ban – I mean come on, they cater to smokers. But again, whatever – it was a losing battle.

    But then I came home. Here, there aren’t choices for employment. You work where you can get a damned job and deal with the atmosphere, whatever that may be. For the first time in my life, I have gone into a smoke shop that has a non-smoker working there – more than one. It has been a shock to go into restaurants that have smoking sections and employees who don’t smoke and some who have health problems that the shs worsens. They keep plugging away, because they don’t have a choice – they work there, or they don’t work at all.

    In Portland, I doubt there was a single smoking friendly establishment that employed non-smokers. Indeed, a great many bars that didn’t allow smoking, employed plenty of smokers, as evidenced by them joining the smoking customers in the out-door smoking lounges. That just isn’t realistic in a place where jobs are very hard to come by. And believe me, jobs are very hard to come by here – in some cases especially if you are too highly skilled, but not in the right skill set (thankfully, I am too highly skilled in the right skill sets – coupled with financial aid and grants to cover tuition, I won’t have to go into too much debt and will make plenty enough beyond that to live).

    Whereas in Portland, it would be pretty much foolish for a non-smoker to work in a smoking establishment (just flat unnecessary, here it is very common.

  75. #75 Tom Foss
    December 3, 2008

    As a non-smoker in Illinois, the recent smoking ban has been something of a godsend (FSMsend?). I’m actually able to go to bars and clubs and enjoy myself, rather than sneak out every ten minutes for fresh air and go home with a splitting headache and reeking clothes.

    Which is not to say that I particularly like smoking bans. I understand the reasoning behind them, but I’d prefer to see something more like an incentive program. Give tax breaks or subsidies to businesses that decide to go smoke-free; require smoke-friendly business owners to inform their employees about the dangers, or require them to consult with the employees before becoming smoke-friendly. It might not be a perfect system, but I’d like to see a little more attention paid to the freedoms of business owners in this situation.

    On the other hand, while I think the other non-smokers here are getting a bit vitriolic, the smokers frequently appear ridiculously nave. Even if there were no evidence that secondhand smoke presents a health risk to non-smokers, the non-smokers would still have the right to decide what they put into their bodies. You may decide to breathe that stuff in, and more power to you, but you can’t make that decision for me. Moreover, I’ve been in restaurants with smoking sections (often placed between the non-smoking section and the restrooms), and I’ve been sitting in open-air stadiums next to smokers: surprisingly enough, gases diffuse. They don’t just stay in one place, and since restaurants tend not to actually put barriers between smoking and non-smoking sections, most restaurants with both might as well have only the one. Unless the establishment is huge, there’s not much hope of escaping it. The same is true for stadiums; it’s not as though the smoke just floats up and out without affecting anyone nearby. And even if it did, stadium seating generally means that there are people seated above you.

    I have a few friends who are smokers; they’ve never asked me to light up or smoke in my car or apartment, and they always put out the butts before they get in. My experience with non-stranger smokers is generally quite positive, and I imagine that the courteous smokers really are a quiet majority. It’s unfortunate that the general picture is instead of the obnoxiously noxious.

    Which is basically the same complaint that we hear about the fundamentalists–they’re loud, they claim to represent the majority, and the nice ones are too quiet and polite and even-tempered to speak up and be heard. It’s not up to the non-religious to make the distinction between the fundies and the moderates when they share the same name and beliefs and support structure, neither is it up to the non-smokers to distinguish between the dinner-ruining boors who puff on cigars in tiny restaurants and the average Joes who nip out now and then for a ten-minute smoke far from the entrance. Moderates, disassociate thyselves. Speak up, and teach your more barbaric counterparts some manners. Otherwise, don’t be surprised when those on the outside act based on the more apparent, more intrusive behaviors.

  76. #76 Danimal
    December 3, 2008

    @CyberLizard: The EPA report you cite has been largely discredited. The EPA moved the goal posts of epidemiology. There was a court ruling that can be found here and a Congressional Research Service report about it that can be found here. While the court ruling was overturned on appeal, basically ruling that the lower court had no jurisdiction, the findings of fact by the court are not in dispute. If I recall correctly, normally in epidemiology a confidence interval of 95% is used. The EPA used a confidence interval of 90% to cook the books to be able to find the second hand smoke is harmful. Had the EPA not done so they would have come up with a null result. Basically they knew want finding they wanted and did what it took to get them. Anyone quoting the report should not be taken seriously.

  77. #77 Leni
    December 3, 2008

    I think the big difference is that we all need to eat. It’s just a matter what we choose to eat.

    Yes, but if the principle is that people who choose to behave in unhealthy ways pay more, then those of us who chose to eat unhealthily should pay more.

    This should probably include people who drink more than the daily thimbleful, too :)

    And as far as those who say that designated smoking areas or proper ventilation can mitigate the problem; you just don’t get it. Smoke circulates in the air. Unless you enclose the smoker’s head in an acrylic sphere and duct the smoke somewhere else, it will circulate. I realise that I’m probably in the minority in that I am extremely allergic to smoke and so affected much more by this issue than the average person, but the fact is that smokers are directly and measurably affecting the health of everyone around them. I am all in favor of eliminating smoking in all public places.

    I’m sorry about your allergy, but as unpleasant as it must be for you, it’s ultimately your problem. There are people who are severely allergic to things like peanuts, chocolate, and car exhaust. They have to deal, and I’m sure it isn’t fun for them, but I don’t think they expect the world to be devoid of those things.

    And you are in the minority. Most of the non-smokers that I hear complain about smoking do so for primarily aesthetic reasons. They complain about the smell and then as an afterthought say something like “Besides, it’s just bad for those poor bartenders and waitresses who couldn’t possibly find work elsewhere!”. Rather than say they support bans just because they don’t like smoke, suddenly (and somewhat mysteriously) they are all concerned about the health of service industry workers, whom we all know mostly get paid jack shit and rarely get benefits.

    I have to wonder, if they were so concerned about the health and well-being of others, why are so many Americans uninsured? Why is it so hard to pass legislation for health care when something like 80% of the population is all pro minimum-wage worker health? Why are the poverty limits set so low that it’s difficult for many to qualify for public assistance despite the fact that they are obviously struggling? Why is it that we only seem to care about the health of of the people who serve us when it’s convenient for us?

    I know, it’s not an argument against bans per se, it’s just something that irks the crap out of me about smoking ban advocates.

    Seriously, I wouldn’t (because you’re allergic), and I know you aren’t being whiny, but sometimes I swear to god I just want to find people like Paul Murray blow smoke right in his whiny, no doubt pinched, anus-like face. And then pee on his curtains just to see which one he complains about first!

    (FYI Paul, smoking isn’t anti-social. Being a jerk is.)

  78. #78 Leni
    December 3, 2008

    P.S. And as someone mentioned, if I were required to pay higher health insurance premiums for smoking, I would be more inclined to lie about my smoking. And less likely to seek help.

    (Just like all you fat people would claim to be vegan marathon runners! Don’t deny it!)

  79. #79 Carter
    December 3, 2008

    Instead of persecuting smokers even more we should be going after doctors. Medicine costs us lots of money for little benefit. Doctors should pay extra in taxes, and the general public should be encouraged to stop respecting doctors, since they don’t deserve it.

  80. #80 Aquaria
    December 3, 2008

    As Leni said, some of us with severe allergies just have to…cope with them. Nobody’s kowtowing to us, that’s for sure.

    I’m severely allergic to most perfumes. This has been hell for me as a postal worker, since plenty of moron brides-to-be think its sooooo romantic to slather wedding invitations in cheap-ass perfume (it’s never the good stuff), or when some fool magazine or department store sends out a mass mailing containing perfume samples.

    I can’t go to most events in enclosed spaces anymore, because of the overwhelming stench of so many deodorants, soaps, splashes, lotions and colognes. The cleanser aisles at grocery stores are no treat for me, either, and forget Bath and Body Works or Macy’s first floor.

    But I live with it. That’s the way the allergen lotto crumbles. I keep epinephrine and Benadryl on hand for those occasions when I can’t avoid a powerful exposure to perfume. Because it’s MY problem, not everyone else’s.

  81. #81 Brian
    December 4, 2008

    @katie

    Yes, which is why I made sure to include this statement regarding BCP:

    Yes, I get that BCP are not prescribed exclusively for this purpose, but I speculate it constitutes a healthy majority, nonetheless.

    I’m not arguing against birth control pill coverage, as I understand that dysmenorrhea is an indication for their prescription. An oversight on my part, however, is that I forgot to include all contraceptive methods.
    For example: I go to a major university, and participate in their student health insurance policy through Aetna. Contraceptives are covered, including but not limited to BCP. So setting aside the additional indications for BCP, what about other contraceptive methods (IUD, etc.)? Are these not primarily in order to mitigate some of the risk of the choice to be sexually active?
    As an aside, information sources about contraception are clearly visible at the student health center, but smoking cessation materials and information are nowhere to be found. Like, nonexistent. Ironically, smoking is a risk in combination with BCP, yet cessation materials are nevertheless not covered.
    ALSO: While out-of-pocket for the month paks of Chantix are hella expensive, an alternative for those who would prefer to break the expense up is for your provider to prescribe individual Chantix pills. It works out to about $36/wk., as opposed to the ~$130 for the month pak.

  82. #82 Tom Foss
    December 4, 2008

    I don’t know how representative this is, but I know the professors at my alma mater had to fight to get birth control covered by their health plan. ED drugs, like Viagra, were already covered, on the grounds that they corrected a medical problem. It seems to me that any health plan which covers Viagra–a drug related to the choice to have sex–should cover birth control pills as well.

  83. #83 Jeremy
    December 4, 2008

    A paid $120/month for Chantix, which was a bit less than cigs cost me. It worked great at suppressing my urge to smoke. Unfortunately, it also worked great at suppressing my urge to do *anything*. Although I went a couple months without smoking, I couldn’t stand the lethargy and depression that went along with it.

    @Tulse:
    “Isn’t smoking a choice? …There is nothing sadder than addicts trying to rationalize their addiction.”

    So which is it? A choice or an addiction? I’m under the impression that an addiction is an involuntary compulsion based on the body feeling as if it *needs* a substance. To me, an addict has about as much “choice” to not use as a hungry person has to not eat. If it was simply a choice, I don’t think most people would consciously choose substance abuse.

  84. #84 MH
    December 4, 2008

    DuWayne, when I stated my intent to stop smoking on a forum I hang out at, almost all the ex-smokers recommended “Easy Way To Stop Smoking”. Read it and you’ll see why. It’s a cheap book, but as you live in poverty (as indeed I do) you can easily find torrents of it in pdf form.

    The other thing I will say is try and get a support group. Forums are great for this (a forum for any subject will have many members who have kicked the habit and who will want to help others do the same). Escaping an addiction is inevitably tough, and it’s great to have understanding people who can be there for you to share both the highs and the lows.

    Finally, although I haven’t noticed any huge positive changes in how I feel physically (I was never a huge smoker), the sense of achievement is wonderful, and I’m sure it will help in overcoming other issues I have to contend with.

    Good luck!

  85. #85 MH
    December 4, 2008

    DuWayne “So for all you “well wishers” who seem so sympathetic to my plight and the plight of other smokers; Fuck You, and excuse me, I need a cigarette.”

    LOL, I know exactly what you mean. The other thing which inevitably made me want to have a cigarette was seeing TV adverts for nicotine patches/gum. Damn you, Nicorette!

  86. #86 Ren
    December 4, 2008

    Isn’t it part of the human condition that our addictions make us sick and a burden to our communities, and none of us is free from an addiction of some sort?

    Diabetics and people with heart disease have twinkies and fast food to thank.

    Smokers have nicotine.

    Hep C (a lot of them) have IV drugs.

    And I could go on and on…

  87. #87 DuWayne
    December 4, 2008

    Leni -

    I absolutely adore you.

    MH -

    Thank you, I’ll look that up. I should also note that I am set to have an appointment with community mental health, who should be able to get me on my meds – which won’t make it happen in and of itself, will certainly help.

    Something that I am working on, which seemed to help several of my friends cut way down on their smoking, is not having my first smoke of the day until I’ve been up for two hours. Granted, two of them still smoke today, but a pack lasts them nearly three days (they’re married).

    I will not be trying though, until I have my kids back, safe with me. Honestly, one of the most difficult aspects of this is having to deal with OR courts and lawyers, which means I am waiting until eleven or noon to actually accomplish anything – waiting makes it hard not to smoke.

  88. #88 MH
    December 4, 2008

    You’re right that one should not try and stop smoking when there are factors that will make it extra difficult.

    I hope you get your kids back soon.

    All the best.

  89. #89 PalMD
    December 4, 2008

    Most of us in primary care know that quitting smoking is pretty much the most important thing you can do to prevent disease and death—OTOH, for people with any type of mental illness and with immediate personal crises, this is often a nearly impossible goal, and we often have to help them get to a place where quitting smoking is even possible.

  90. #90 llewelly
    December 4, 2008

    How, exactly, is smoking a `liberty’?

    Control of your own body – including what goes into it – is the most important liberty. Nearly everyone who drinks alcohol changes their conversational habits while intoxicated. Choosing to drink affects what they talk about – and therefor affects their right to free speech. The same case can be made for many other drugs, and every activity.

    The difficulty is that some of the smoke inevitably ends up in someone else’s body, unless the smoker is isolated.

  91. #91 Tulse
    December 4, 2008

    Control of your own body – including what goes into it – is the most important liberty.

    Are addicts still in control over what goes into their body?

  92. #92 Anonymous
    December 4, 2008

    “I, personally, have never heard of entire apartment complexes that have banned smoking, although given the nature of the structures and the close quarters of the residents, it’s probably a good business decision if complexes offer such amenities. Many hotels have gone that direction. But I wouldn’t suggest that legislation mandate it.”

    Living in Boston, MA (a state that has passed laws against smoking inside bars and restaurants), I find that a lot of leases have no smoking clauses built into them. I suppose you could smoke inside, but if you were caught you could wind up homeless.

    As a former smoker, and someone who started late, some things to add to all of this:

    Even as a smoker I liked that we had to go outside at the bar/restaurant/club. It meant that my food didn’t smell of it, that the dance floor didn’t get covered in clouds of smoke so thick your eyes stung, that my clothes didn’t get burned by someone else’s cigarette, and that I could not chain smoke or drink continuously, as they were mutually exclusive behaviors.

    Sending everyone outside creates a whole subset of the social aspect of places like bars. I made more friends standing outside by myself holding a cigarette than I ever did inside. This can in turn make it harder to quit, as now the behavior is reinforced by other smokers. Even when I was at home and had to leave the apt to smoke, this meant that I was also taking a walk or running errands, rather than sitting in front of my computer all day.

    I have trouble imagining smoking outside in public places being effectively legislated away. I can see (and have, since I quit and became more sensitive to the smell, experienced) how encountering a smoker on the sidewalk is annoying, but honestly, we’re walking through city streets, at least it covers up the stench of piss and car exhaust. Or cross the street, or pick a different route. A smoker can consider himself courteous and not realize he’s bothering the person walking five feet behind him. Or sit on a park bench in a secluded corner and get glared at when mom with kids decides that downwind of the smoker who just lit up is the perfect place to have a picnic. I think nonsmokers should have to pay attention to their surroundings, too. If you don’t want to smell it, don’t sit next to someone with a butt in their hand.

    And finally, berating us for a horrible choice made years ago? Not an effective way to convince people to quit. In fact, just going to piss people off, and thus make them less inclined to quit. Which is not easy. Smoking is one of those few drugs with few immediate negative side effects. You can drive and smoke. You don’t OD if you quit and start again. And as has been mentioned before, there’s almost no support for quitting. What is there is generally not actually very helpful.

    Personally, I got lucky. I had been trying to quit for months (getting up to three weeks without a cigarette at one point), when I made the mistake of having too much alcohol at a party. The flavor my brain decided to latch on to as having made me sick? Tobacco. Can’t touch it anymore.

  93. #93 The Perky Skeptic
    December 4, 2008

    DuWayne, I hope all goes well in getting your kids back! If I might attempt to cheer you with a mention of the movie Airplane, “I sure picked a bad day to quit smoking!” :)

    PalMD, the thing about having to treat mental illness first is right on the money. I’ve got a great friend who has been trying to quit for years, but he has a severe case of OCD, and it’s making it really tough! Whereas, my father-in-law, who smoked for fifty years, went on Chantix for one month and has never touched a cigarette since.

    Seems to me that makes it all the more urgent that insurance subsidize smoking cessation– because it is an urgent medical need, because not everyone has life circumstances that make it easy, and because there are people who really REALLY want to quit who are nonetheless struggling.

  94. #94 Teresa
    December 4, 2008

    DuWayne,

    Best of luck to you. I really wish you the best of luck. I know people in similar situations, and it just sucks. there’s little else to say about it. It sounds like you have a good start on at least prioritizing your problems.

    I hope you get your kids back soon, get mental health care, and find work…and help quitting smoking.

    Please don’t let it overwhelm you. I imagine some days, it’s heroic just to keep head above water.

  95. #95 makeinu
    December 4, 2008

    Well, I’ll go out on a limb, and quote Vonngegut:

    “Let us be perfectly frank. For practically everybody, the end of the world can’t come soon enough. [Cigarettes are] a fairly sure, fairly honorable form of suicide.”

    Give them what they want: death.

  96. #96 DuWayne
    December 4, 2008

    makeinu –

    You know, there was a time when that was pretty much what I wanted – not so much wanted, but just didn’t care about. All that death was, was a potential consequence and what I assumed would be the result of the way that I was living. I didn’t want to die so much, as it was an acceptable consequence of doing what I wanted to do. I’m now older than I actually thought I would manage to get and considering the immense amount of crap I put into my body when I was young, I’m in remarkably good health – better than a lot of other early thirties I know.

    Smoking is one of my few holdovers and one that helps me keep it together. Coffee, another really nasty substance for ones health, is another holdover. But the mroe negative aspects of my neurological issues are at least partly defined by a stunted production of endorphins and my coffee and smokes help compensate for that. At the moment, I have no medications to help with either and I sincerely hope that when I get on meds, I will be able to quit smoking. Given my previous experience with pure amphetimine (ingested in tablet form) and more recently, ritalin, I won’t have an issue with the coffee.

    But I can truly and honestly say that I no longer consider death a reasonable option. I have two boys who are in dire need of me being alive for a good long time to come. Especially given that I am probably going to have to care for them with little of momma’s help, as she really doesn’t want to get help with her neurological issues. And I really want to be capable of doing everything I can to ensure that they end up not like their parents did when we were young.

  97. #97 The Chemist
    December 5, 2008

    Having a brother who smokes is frustrating. I have never smoked a thing in my life. Still, Unless it’s being blown into my face, or if I’m eating, I don’t find cigarette odor particularly offensive. Instead it frustrates me because- simply, I want my brother to be healthy. I mean, I have other relatives who smoke, certainly. My grandparents for example. However with them, they are well past their primes, and while they are feeling some of the effects of long term tobacco use, it’s frankly a little too late to really worry about it (considering they practically started at ten). My brother on the other hand, has his whole life ahead of him (to use a cliche).

    He keeps telling me he wants to quit, if only because it’s sucking up money he could be spending on car insurance and cool stuff. I do notice him smoking a lot less, (something like having an XBOX 360 seems to actually help keep his mind away from the EEEEBil!) He’s beyond the denial stage of addiction, where he claimed he didn’t need to quit or that he could whenever he wanted to.

    So when people talk about how cigarette smokers help add revenue etc. etc. I don’t think it’s beyond the pale to kind of take a step back and say- You know, we might actually be concerned with people’s welfare here.

    Do I think a smoking ban will help? No.
    Do I think excessive taxation does much to dicourage smoking? There’s a limit- it’s an addictive substance with a high rate of recidivism.
    Do I think that if there is a solution, it will be easy? Not really.
    Do I think we should at least give a damn? Abso-fucking-lutely.

  98. #98 catgirl
    December 5, 2008

    For me, it’s not the nicotine that’s a problem, but the smoking of it. I’m very allergic to second-hand smoke (not just irritated like most people). Because of my allergy, banning smoking inside simply is not enough, because I have to walk through a cloud of smoke to go through any doorway, or even walk down the street. Instead, people who want to use nicotine should simply switch to chewing tobacco, gum, patches, liquid nicotine, or even inject it intravenously. I know it’s very difficult to quit, and I don’t demand that people stop using nicotine – just use it in a different way that doesn’t infringe on my right to NOT use it. I mean, if I knew someone who was allergic to peanut butter, I would still eat peanut butter; I just wouldn’t light it on fire and blow it in their face.

  99. #99 Danimal
    December 5, 2008

    @catgirl: You make some very good points. I would argue that if there still were venues meant for smokers, you would not have to go there. Go to those meant for non-smokers and hopefully those that do smoke will stay 50 feet from the entrance. Even if they do not stay 50 feet away are you saying a few seconds passing through smoke effects you?

  100. #100 Anonymous
    December 6, 2008

    @ LanceR, JSG

    “cost of chantix is about $120.00/month.
    Where do you shop? I was quoted that *per week*.”

    Chantix varenicline
    Manufacturer/PricingManufacturer: Pfizer Inc.DEA/FDA: RxApproximate Retail Pricefrom http://www.drugstore.com: 1 mg (1 disp pack, 56 ea): $124.99

    Quitting smoking is extremely difficult. It is one of the most addicting habits sold. Its addiction powers may capture you after one cigarette. Nicotine receptors are easily saturated and may take weeks to desaturate, producing withdrawal. Eventually, the desaturation time is less and less and withdrawal comes earlier and more severe.

    Those who smoke likely have been told the risks. Whether or not insurance should or should not fund smoking cessation programs does not change the fact that every smoker needs to quit for their own safety.

    Consider the personal financial costs.
    A habit that costs $5 a day over 35 years = $64,000.00
    If, starting at age 30, $5/day is put into a 5% earning bond fund or money market account in a Roth IRA, over 35 years = $173,777.00.
    This would amount to $1,142.09 a month of tax free retirement income until age 85. As the non-smoker would likely have less health problems and live longer, this ain’t bad.

  101. #101 LanceR, JSG
    December 6, 2008

    Yes, you may be able to find Chantix cheap near you. But it is not that cheap everywhere.

    See here for prices that range up to $475 for those same 56 pills.

    I *have* checked these things out.

  102. #102 DuWayne
    December 6, 2008

    LanceR -

    If you have a script for Chantix, you should be able to use a mailorder pharmacy and get it considerably cheaper. My grandmother has shit for script coverage and pays the full amount for most of her drugs. The mail order pharmacy sends her two month supplies for the price of one month.

  103. #103 The Blind Watchmaker
    December 6, 2008

    @ LanceR, JSG

    If you look at the link that you provided, the $475 price was for 224 of them. This is a nearly a 4 month supply and is a good deal (although, the usual treatment duration is 3 months).

  104. #104 Leni
    December 6, 2008

    DuWayne wrote:

    I absolutely adore you.

    It’s sweet of you to say :)

    FYI, I just got back on the wagon after two years because I ran out of inhalers and was too cheap to shell out the 180$ for another year supply. Stupid, I know, especially since I could afford that.

    But the inhaler was very successful (even enjoyable!) for me while they lasted, in combination with Wellbutrin (which I think saved me from turning into a complete asshole those first few weeks). You have more control over the dosing (unlike those damn patches) and you don’t need to chew something disgusting that makes you have to spit a lot because you’ll get sick if you swallow it.

    If you ever get the opportunity, I recommend it. If you don’t have insurance, maybe you have a friend who does and would also like to quit. I would have shared and then kicked in with a friend to by them after my insurance ran out if I could have. Or if I’d planned better. One box of those inhalers will keep you in good for quite some time, especially after you get to the point where you only need them for emergency nic-fits.

    catgirl wrote:

    I mean, if I knew someone who was allergic to peanut butter, I would still eat peanut butter; I just wouldn’t light it on fire and blow it in their face.

    I take it you don’t drive, use motorized public transport or use combustible engine generated power ever then either?

    I mean that a little less snarkily that it sounds, because I do feel for you. It sounds like it’s really unpleasant and frustrating. But, and I’m sorry if this sounds harsh- you aren’t the only allergy sufferer out there. There are a lot of people who have it worse than you. I would guess perfumes are a lot more prevalent than cigarette smoke, especially in the workplace.

    And people aren’t even addicted to perfume!

    That said, if the inhalers were non-prescription I would be far more inclined to buy them just because I’m lazy and the reduced health hazards, hassle and expense would a definite incentive. Here’s hoping someday soon!

  105. #105 SD
    December 8, 2008

    What about cigars?

    I enjoy a cigar every few weeks to a month- fishing, walking the dog, at a cigar bar.

    Where do we stand? We don’t smoke nearly as much, usually in specifically designated places or so far away from anyone else (even cig smokers often can’t take the smell). We don’t smoke often enough(nor inhale at all) to dramatically increase cancer rates, so we’ll probably live as long as other non-smokers (assuming we can make it through the gauntlet that is life).

  106. #106 Rr
    December 8, 2008

    1)— Making people the problem instead of the bad things they do tends to be dangerous and misdirecting. “Smoking – What should we do about it?” is a significantly more useful way of thinking about the problem. People are already paying dearly for their mistakes, regardless of whether they realize it or not. Punishing them further for it is counter-productive and will just result in knee-jerk defensive reactions from them. Reward good behavior instead.
    I wish I could give any good suggestions, but apart from the ridiculously obvious suggestion to actually help with physical means to quit as well, rather than just advice, I can’t think of anything good at the moment.

    2)— Regarding perfume in various products: Get people to switch to bicarbonate based deodorants (deodorants that actually deodorize, instead of ones that mostly just cover any smell up) [on top of get healthier], and help perfume abusers realize that emanating a cloud of perfume is as distasteful as wearing vomit – especially as different people have different tastes: The scent one normal person may adore, another normal person may find nausea-inducing (by normal I mean as opposed to the poor bastards who actually are allergic to perfumes).
    Most mainstream perfumes do negatively affect the health of their users and anyone stuck with them, this is just not well known. Though it’s probably nowhere as bad as smoking, heavy perfume usage still is bad for the health.

  107. #107 Carolyn
    December 9, 2008

    I don’t know what’s worse. Claiming to hate the behavior is one thing. Taxing it another.

  108. #108 Marc Abian
    December 12, 2008

    Smoking bans in places of recreation only require the smoker not to smoke for an hour or two. It shouldn’t be a big deal. Meanwhile someone smoking near me is a big deal. I honestly would prefer to be punched in the stomach.

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