In searching for the obscure, do not overlook the obvious.
HIPPOCRATES
Our goal should be to prevent tobacco death. Smoking already kills more people than all the world’s infectious diseases combined: the number has now reached six million per year and will stay high for decades even if everyone stops smoking tomorrow. The industry wants us to think about tobacco as a “solved problem” or an issue from the distant past, but the reality is that most tobacco death lies in the future. Only about 100 million people died from smoking in the twentieth century, whereas we in our century can expect a billion tobacco deaths if we continue on our present course. A public health catastrophe is unfolding, and even keeping the final death toll under 300 or 400 million—which is certainly possible—would be a great success. None of these deaths are necessary: tobacco mortality is easily preventable. And the solutions are actually fairly simple.
It is no longer fashionable to talk about “magic bullets” in medicine, but here we really do have a magic bullet, requiring (in theory) nothing more than the stroke of a pen. Ninety-plus percent of all tobacco death can be prevented by banning the sale and manufacture of cigarettes. Even short of a clean sweep, however, there are many smaller steps that could help reduce tobacco mortality. Which is not to say that the political obstacles are not formidable; we live in a world of powerful vested interests. So it is useful to have short-term goals as well as higher aspirations.
Here first are ten relatively obvious solutions, followed by ten that are somewhat less obvious, including proposals for redesigning the cigarette itself.
1. Ban smoking in all indoor public places and in outdoor spaces where people congregate. Public parks and beaches should be completely smoke-free, and smoking should not be allowed on streets or sidewalks of densely populated urban areas. Smoking should also be barred from apartment complexes and any other form of housing where fumes can move from one domestic unit to another. People don’t seem to realize that in crowded urban spaces—outdoor restaurants, for example—smoke from other people’s cigarettes can generate toxic exposures comparable to those from indoor smoking.
2. Increase cigarette taxes. Tobacco has a price elasticity of about .4, which means that for every 10 percent rise in the price of a pack we can expect a 4 percent fall in consumption. Some will say this unfairly taxes the poor, which is why taxes should be combined with subsidies for smoking cessation services, including nicotine replacement therapies and non-drug services (such as hypnotherapy) made available free of charge. Taxes are already high in many parts of Europe, and in some places we have $12 and even $15 minimum-price packs. But twice this amount is not impossible. Americans can still buy cigarettes for only $4 or $5 per pack, and in tax-free zones (military commissaries or duty-free shops, for example) they can be even cheaper. All loopholes of this sort should be closed, and taxes should be collected at the point of production—not at the retail counter—to prevent smuggling and illegal sales via the Internet. New tax revenues should be used for tobacco control and cessation, to break the dependence of governments on the continued sale of cigarettes. Pressure should also be exerted on countries with low tax rates to raise those rates to prevent buttlegging and organized crime more generally.
3. Ban all cigarette marketing, including all advertising and promotion. Bans in certain media (magazines, billboards, television, etc.) are already in place in many countries; these should be extended to cover all marketing and promotion, including direct mail, movie plugs, viral marketing, brand stretching (“Marlboro gear”), cultural sponsorships, coupons, Internet offers, and advertising at retail point of sale. Package design is an effective and ubiquitous form of advertising, and no cigarettes should be sold in anything but a plain white wrapper accompanied by a graphic warning. Advertising bans should cover not just the product but also the name of the company making that product, and manufacturers should be barred from sponsoring sports, music, or any other cultural event, including philanthropy designed to create an illusion of “corporate social responsibility.”
4. Make warning labels on cigarette packs large, graphic, and disgusting. Tobacco packs are miniature mobile ads and the most common way smokers encounter their cigarettes. Psychologists have studied warning labels and found that certain kinds are more effective than others; some of the most graphic are powerful enough to make people return their cigarettes, and different images will of course resonate differently in different cultures. In Canada, for example, the most provocative have been images of a diseased mouth and teeth, whereas in Brazil the images of premature babies have been quite off-putting. Research should also continue to determine which images are most likely to discourage smoking.
5. Bar the sale of cigarettes everywhere except for special state-licensed outlets. In the United States, as in most other parts of the world, it is far too easy to find and purchase cigarettes. Several states allow hard liquor be sold only in state-sanctioned stores, and the same should be true for cigarettes. In the meantime, cigarettes should be removed from “impulse” purchase areas at checkout counters and made available only by request from a sequestered source. And to help prevent youth access, cigarettes should be sold only by the carton and not within one thousand feet of a school. Vending machines should also be banned, along with distribution of free samples and brand-themed merchandise.
6. Place an R rating on all feature films depicting smoking. Exposure to smoking in movies causes young people to take up the habit; indeed there is no more effective form of advertising. Smoking in Hollywood films grew substantially in the 1990s, and by 2002 three quarters of all American films portrayed cigarette use. An R rating for all films showing smoking would help reduce tobacco use, since most of the profits in this business come from youth-audience films. Hollywood movies have a global reach, which means that the impact of such a rating would extend beyond the United States. It would help to denormalize smoking, which in most parts of the world is still regarded as rather like drinking coffee or eating a bar of chocolate. Present-day tobacco brands should never be shown in general-audience feature films, and producers of films displaying cigarette use should certify that they have not accepted money or goods from a tobacco company or its agents. Directors would still be free to include smoking, just as they are free to include nudity or foul language; they would just have to accept a restricted audience.
7. Stop all tobacco subsidies and supports. Governments throughout the world encourage the planting and cultivation of tobacco, treating it as an ordinary agricultural commodity like corn, beans, or rice. Why should farmers be encouraged to grow the world’s deadliest crop? Tobacco has benefited from state-sanctioned protectionism, and what is needed are incentives for crop substitution. Global free-trade agreements should also not treat tobacco as an ordinary commodity but rather as the product of a rogue agricultural enterprise—an economic “bad” and not an economic “good.” Trade in tobacco should be treated more like the trade in weapons, which is tightly controlled and falls outside the governance of global trade agreements.
8. Increase funding for tobacco prevention and cessation to a level commensurate with the harms caused. Nowhere in the world is tobacco prevention—including smoking cessation—funded on a scale appropriate to the magnitude of its medical cost. In Sweden tobacco prevention receives only a mere 0.003 percent of the health care budget, even though treatment of diseases caused by tobacco consumes more than 8 percent of the nation’s health care costs. In China there are perhaps fifteen people working full-time on tobacco prevention while more than 15 million work to get people to smoke as much as possible. The allocation is off by several orders of magnitude. Tobacco mortality is easily preventable, and tobacco control can save a nation money by reducing medical costs. Tobacco prevention also brings with it side benefits in the form of reduced harm to the environment, savings on costs from fires, and savings for individuals freed from the financial burdens of lifelong addiction. Private philanthropists (notably Mayor Michael Bloomberg of New York and Bill and Melinda Gates) are funding creative work, but governments also need to take more responsibility. Cessation promotion should be part of this: toll-free numbers (e.g., 800-QUIT NOW) should be established to direct people to cessation services, and research into creative new means of cessation should be funded.
9. Teach tobacco prevention early, graphically, and creatively. The lesson is not just that cigarettes kill but also that the industry uses devious means to hook you. Crucial is to instill a sense of informed discontent: children should begin learning about tobacco mendacity (“Look how they are trying to trick you!”) in their third or fourth year in school, which is also about when they should learn that humans share a common ancestor with apes and have duties to safeguard biodiversity. Megafacts of this sort are empowering and must be taught to help boost civic literacy and environmental responsibility. Children should be taught that cigarettes contain a menagerie of poisons, and contests should be sponsored to encourage kids to develop their own ideas on how tobacco impacts life and our ecosphere—and what should be done about it. Prizes should be large and numerous, with rewards going to imaginative insights and creative presentation. The rhetoric in any successful campaign must avoid paternalism and should strive to recapture high ground values of life, liberty, and the pursuit of happiness. The struggle, after all, is not about health versus choice, or purity versus freedom, or parents versus teens, or the righteous versus the weak, but rather a useless polluter versus the rest of us.
10. Listen to the voices of smokers. Half of all smokers will die from their habit, and we need to know more about what they think should be done, especially those who have contracted diseases from smoking. What do they advise? They are on the front lines, and their voices must be heard.
And now for a series of less obvious imperatives, most of which involve imaginative cigarette redesign or governance of production.
11. Make cigarettes uninhalable by raising smoke pH. Cigarettes have been designed to create and sustain addiction, but they could easily be redesigned to be far less deadly—and not at all addictive. Cigarettes would be far less lethal, for example, if the pH of cigarette smoke were restored to levels prevailing prior to the invention of flue-curing. Flue-curing lowered the pH of cigarette smoke, allowing it to be inhaled; this fatal design flaw has spread throughout the world, part of efforts to make cigarettes ever “milder.” Cigarette smoke pH is easily manipulated, and no cigarette should be sold that delivers smoke with a pH less than 8. By returning smoke pH back to where it was prior to the nineteenth century cigarettes would no longer be inhaled, and most of the lung cancer hazard would vanish. Much of the appeal of smoking would also disappear, especially for “starters.” A century of morbid cigarette engineering would be reversed and millions of lives saved. Care must also be taken, however, to ensure that cigars are not redesigned to become low-pH inhalable “big cigarettes.” FDA authority should therefore be extended to cover all tobacco products, to make sure that new design mandates for cigarettes are not circumvented by some other form of nicotine delivery.
12. Reduce the nicotine content of cigarettes. Nicotine is the sine qua non of all tobacco addiction. And if we can take safrole out of root beer and lead out of paint and asbestos out of insulation, then surely we can take nicotine out of cigarettes. This is not hard from a manufacturing point of view—nicotine-free cigarettes have been available since the nineteenth century—and few people will continue to smoke without this deadly hooker. The new FDA in the U.S. is barred from eliminating nicotine entirely, but nothing prevents it from establishing a maximum of, say, 0.5 or even 0.4 milligrams per cigarette, reduced from present values of about 10 mg. (Here again we are talking about total nicotine in the cigarette, not smoke delivery; see the box on page 380.) This would still allow people to smoke for “taste” and whatever pleasure comes from fondling the cigarette or gazing at its smoke; cigarettes with dramatically reduced nicotine in the rod, however, would no longer have the power to create and sustain addiction.
13. Tax or ban the machines. We often hear about the importance of cessation of consumption but rarely about the value of cessation of production. Three or four companies dominate the world’s cigarette-making-machine business, and high taxes should be levied on any factory wanting to make or sell such machines, or any company wanting to import them. Global cigarette-machine manufacturing is dominated by the Hauni corporation in Hamburg, Arenco-Decouflé in Paris, G.D (Generate Differences) in Bologna, and Molins in London. The Hauni company is the largest, but Italy’s G.D offers stiff competition. Hauni’s and G.D’s machines are the deadliest in all of human history, cranking out twenty thousand cigarettes per minute, nearly 10 million per eight-hour shift. And since one person dies for every million cigarettes smoked, this means each of these machines causes the death of ten people per eight-hour shift. Taxing or banning these machines would be an excellent way to lower tobacco mortality. Manufacturers would pass these higher production costs on to consumers, but taxation would also create an incentive to switch to less deadly products. Tobacco control advocates have ignored this crucial link in the chain of causes leading to cigarette death, but the fact is that manufacturers also have choices, much as they would like us to think they do not. Caveat emptor is not enough; we should not place all the burden of fateful “choice” on smokers. We have to go to the root of the problem and stop the machines: caveat fabricator!
14. Put an end to research sponsored by the tobacco industry at all colleges and universities. The companies have long sponsored research to boost their credibility, using the good name of Stanford, Harvard, or the University of California to claim, in essence, “How can we be so bad if such fine institutions are willing to work with us?” The companies use these sponsorships to cultivate experts and to twist the substance of science in their favor. Ending such collaborations would improve research integrity and help scholars who hold unpopular opinions repudiate charges of being “hacks” for the industry. If you really think nicotine-coated stents might help prevent heart attacks, then stop taking tobacco money, and people might actually believe you! If you really want to show that pilots fly better under the influence of nicotine, then do this research with untainted funds, and you won’t be accused of selling your soul. Barring cigarette sponsorship is crucial for both academic freedom and scholarly integrity.
15. Sue the racketeers! Litigation can be an effective means to limit the power of the industry, and the cost of successful suits will be passed on to consumers in the form of higher prices—which means that litigation functions more or less as a (rather inefficient) cigarette tax. Few countries take advantage of this opportunity; most of the world’s litigation has taken place in the Americas and, to a lesser extent, Australia and Great Britain. Japan has had only one small trial, and there are a scattered few elsewhere. Litigation can help force documents into the open, revealing the scope of the industry’s chicanery. This can then be used as a springboard to further health advocacy and disease prevention.
16. Establish a single-payer national health care system offering universal coverage. Some countries won’t need this advice, since they already have such systems in place. The United States is virtually alone among the richer nations of the world in having no single-payer medical system. The only good to have come from this is that some powerful insurance companies and governments have been led to sue the industry, hoping to recover some of the financial costs of smoking. Establishing a national health service would force governments to shoulder some of this burden and help bring to light the social and human costs of cigarette complacency. Governments are more likely to take serious steps against tobacco when they realize that the cost of treating cigarette maladies exceeds the benefits generated through cigarette taxes.
17. Recognize tobacco as a significant source of toxic pollution and environmental destruction. Tobacco manufacturing is costly from an environmental point of view: 23 million pounds of pesticides are applied to tobacco every year in the United States alone, for example, and far more globally. This has environmental consequences but is also a waste from the point of view of scarce global resources. Millions of people make their living growing and selling the golden leaf, and substantial planetary resources are squandered in the process. Tobacco cultivation is also a significant cause of deforestation. Old growth forests continue to be razed to establish fields for planting tobacco and wood for fuel for curing. Every year, an old growth forest the size of twenty Manhattans is cleared to bring new tobacco fields into cultivation. Massive quantities of fossil fuels are consumed during the growing, manufacture, and transport of tobacco, all of which contributes to greenhouse emissions and the global climate crisis.
18. Be creative in the language we use. We hear lots of talk about “tobacco control” but not enough about “tobacco prevention” and “prevention of tobacco death.” And suffering. Control talk is a bit defensive and has a regulatory ring out of synch with the magnitude of the catastrophe. Control talk implies a certain accommodation or collaborative tolerance, which is why we don’t talk about “asbestos control” or control of lead in children’s toys. We can’t stop floods, which is why we have “flood control.” And it is an oxymoron to talk about socially responsible cigarette manufacturing; we might as well talk about socially responsible traffic accidents or the proper way to drive while drunk. The industry has captured much of the rhetorical high ground here, denigrating talk of “bans” or “prohibition” as beyond the pale. We need to recapture this rhetorical advantage and broaden how we envision smoke-free futures. The industry presents itself as the natural ally of liberty, romance, and the good life lived to its fullest—values most of us would hold higher even than health or longevity.1 The public health community needs to learn that these “higher values” must be embraced if we are to stop cigarette suffering. We also need to learn to call a spade a spade, even if that means talk of killer machines, toxic polluters, world-class liars, cancer mongers, drug lords, child abusers, pulmonary criminals, death dealers, RICO racketeers, and so forth. The so-called vilification clause of the Master Settlement Agreement’s Public Education Fund (administered by the American Legacy Foundation) bars any use of such monies “for any personal attack on, or vilification of, any person,” but the rest of us should resist the industry’s rhetorical bullying and sleight of hand.
19. Expose cigarettes through film and fine arts. The California State Tobacco Control Program and the American Legacy Foundation’s Truth Campaign have done a great deal to dramatize the duplicity of the industry and the ravages of smoking. Filmmakers and journalists as a whole, however, have done little to capture and dramatize this catastrophe. We need movies on the killer machines of Hamburg and Bologna and on how Big Tobacco’s denialist tricks were adopted and used by deniers of global warming. We need animated renderings of how tobacco attacks the heart and nicotine rewires the brain; and we need hard-hitting exposés of how transnationals penetrate local cultures. We need graphic public art treating the corruption of science and tobacco’s threat to the environment—including contributions to global warming. And Hollywood needs to switch sides.
20. Expand our imagination of what is possible! This is the imperative from which all others should follow. Nothing that is good, true, or beautiful is ever achieved without a measure of creative fantasy. If phasing out tobacco seems out of reach, this is only because our imaginations are impoverished. Recall that people once found it hard to imagine courtrooms without spittoons, or television without tobacco ads, or smoke-free restaurants, but who now regrets those decisions? The industry fought hard to keep smoking on planes and in elevators, but who now feels this as a loss of human freedom? The industry fought hard against warning labels and bans on vending machines and sports sponsorships; all were denounced as the death of liberty, but who now would bring those back? Who now misses being able to light up on a crowded bus or train? Surveys show that even smokers appreciate smoke-free settings, since it gives them an incentive to quit.
There is one last recommendation I shall make, which in the final analysis trumps all the others: The sale and manufacture of cigarettes must be banned. This is the simplest way to approach disease prevention and would obviate the need for most other solutions commonly proposed. It is remarkable how seldom this simple solution is entertained. How and why did the idea of a comprehensive ban come to be so far outside our ordinary imagination? Why does the end of cigarettes appear so unthinkable? Why do we assume that cigarettes, like the poor of biblical lore, will always be with us?
The short answer of course is the power of the industry, which acts as a virtual state within a state to influence policy and what we imagine to be possible. (Global revenues for Altria in 2009 were $25 billion, which makes the makers of Marlboro cigarettes richer than half the nations of the world.) Governments also fear losing the tax revenues that flow from cigarettes, and there are fears that smokers will revolt or smugglers run rampant. There is also, though, the myopia that looks for solutions only in the realm of “consumer choice” and “free markets.” Our bizarre starting point is the well-stocked shelf of cigarettes, to which we respond by begging people not to purchase them. Nothing impedes the trucks that deliver the cigarettes or the factories that churn them out by the billions. We are led to believe that “information” and “choice” are the answers—however compromised by the grip of addiction. We are told that banning cigarettes would be tantamount to Prohibition, which we all know has been tried and failed.
This specter of 1920s-style prohibition is commonly invoked, as if the prohibition of alcohol were an appropriate comparison. It is not. Alcohol and tobacco are very different. The most important difference is that alcohol, unlike nicotine, is a recreational drug. Many people like to drink, and most do so responsibly with little or no harm to their health. Only about 3 percent of all people who drink are alcoholics; the overwhelming majority of “drinkers” do so without compromising their freedom. They are not addicts, which means that apart from that tiny minority of abusers, they choose to drink. That is the main reason Prohibition failed: people like to drink and can usually do so responsibly and in moderation.
Tobacco presents us with a very different situation. Nicotine is not a recreational drug. Most people who smoke wish they didn’t, and most smokers (90 percent) regret ever having started.2 That is because most smokers are addicted—80 to 90 percent, compared with the 3 percent among consumers of alcohol. Few people who drink regret their indulgence; few will say, “Gee, I wish I wasn’t going to have this glass of wine tonight.” Smokers are quite different; most smokers do not enjoy it; they smoke because it relieves their cravings, and they don’t feel they can endure the pain required to quit. Alcohol and nicotine are very different in this respect, which is crucial to keep in mind when considering what must be done.
One thing I have noticed after many years of exploring this question is that there are really only two groups who take seriously the prospect of a total cigarette ban: smokers and tobacco industry executives. Smokers are open to the prospect, because they usually know they have a problem and need help. They want this monkey off their backs. They are often not the wealthiest people in the world and are acutely aware of the money they are wasting. They don’t like the idea of higher taxes, because they know they will probably end up just paying more to scratch the diabolic itch. They regret having started and realize that “strong medicine” is needed to help them stop.
The archives make it clear that the industry has been anticipating the end of cigarettes for quite some time. Tobacco companies have no special love for cigarettes; they make them only because they know they can profit from doing so. And they would just as soon shift to something else, if their stockholders could be satisfied. Recall that William Farone, director of applied research at Philip Morris from 1976 to 1984, was hired to help guide the firm into a post-tobacco era; the company had bought Miller Beer and 7-Up as part of this effort and for a time considered getting entirely out of cigarettes. (Farone recommended the company buy Genentech—which would have been a smart move.) Recall also how hard the companies have worked to make a world without cigarettes seem unimaginable. Prohibiting cigarettes is cast as a grave threat to the liberties we hold dear.
If banning cigarettes seems like a drastic act, that is partly because we have been led to believe that prohibition as a general policy is impractical—or insufferable. The reality is that there is much in life that we prohibit, and for very good reasons. We prohibit slavery and child labor and a thousand varieties of crime, from murder to mayhem. Most laws are prohibitions, as is a great deal of morality (think of the Ten Commandments). We ban foods that contain poisons and drugs with deadly side effects. We’ve banned leaded gas and asbestos insulation, and we don’t allow ordinary citizens to possess (most) military-grade weapons. Some bans are site- or age-specific: you cannot carry knives with you onto an airplane or into a school—and lots of things allowed for adults are off-limits to children. In a sense we live in a world awash in bans, a world radically delimited by constraints that most of us take for granted and would not want to see disappear. Many such prohibitions we think of more as protections, which we unthinkingly accept as crucial for the full expression of human liberties.
California bars the import of certain kinds of plants and animals, for example, to prevent pathogens from hitchhiking into the state. Do California farmers mind such prohibitions? How free would California farmers feel, having to cope with a ravenous new fruit parasite or an unstoppable nematode? Addictive psychoactive drugs are banned throughout the world, because of fears of potential abuse (heroin and cocaine, for example). Would we feel ourselves freer by allowing the sale of heroin on every street corner?
And what about hazardous materials, or extra-powerful poisons or weapons? Handguns are banned in many parts of the world, but even in America a private citizen is not supposed to own a sidewinder missile or armor-piercing ammunition. Are we happy to have such prohibitions? And how about the United Nations’ prohibition of the use of dumdum bullets or chemical and biological weapons? Would we be freer with such items in broad circulation? Are we unduly hamstrung by the Geneva Convention, or international rules governing how prisoners must be treated, or treaties prohibiting the proliferation of nuclear technology?
Safety is perhaps the most common rationale for modern prohibitions. Employers are barred from exposing workers to hazardous substances, and restaurants cannot serve food from filthy kitchens. Aren’t those good prohibitions? And what about laws punishing the fouling of public air or water, or laws barring products that threaten the health or safety of children? Childhood safety is protected by many different kinds of laws, including consumer product regulations. Toys cannot be sold with small pieces that can detach, posing a swallowing hazard. You cannot sell a baby crib with the bars so far apart that a child might squeeze through, risking strangulation. You cannot sell toys coated with lead paint, or pills in bottles without safety caps. Should we be free to market such products?
Food and drug laws include prohibitions that few of us would want to see relaxed. Food manufacturers are barred from using additives known to cause cancer; they are not supposed to include filth or misrepresent contents on packaging. Safrole (from sassafras) is now banned (in the United States) for use in root beer but also for use in perfumes and soaps by the International Fragrance Association. Six different food dyes used to color artificial butter were banned in the United States in the 1950s, when experiments revealed these could cause cancer.
Of course not all industries are equal in their power to resist such bans: recall the American Cancer Society’s observation from 1956 that if the same evidence indicting cigarettes had been found against spinach, the leafy green would not be legal for very long. Most consumer products suffer far greater scrutiny. For pharmaceuticals in the United States, the burden of proof now lies with the manufacturer, which cannot market a drug until it has passed strict safety tests. Mandatory testing of drugs is surprisingly recent, and largely a response to widely publicized abuses. I’ve mentioned the sensational case of diethylene glycol, which killed over a hundred people in the 1930s, but there are many other instances where harms have come from untested medications. Thalidomide was commonly used (in Europe) as a painkiller and an anti-emetic against morning sickness, prior to its recognition (in the 1950s) as a cause of birth defects. The drug caused more than ten thousand malformations worldwide prior to its removal from the market. In the United States the scandal led to a ruling that drugs must be tested prior to release—which means that untested drugs are, in effect, prohibited, banned.
Automakers are barred from selling vehicles that do not meet safety standards. We may not think much about it, but every automobile on the road today is a rolling embodiment of hundreds if not thousands of mandatory performance standards. You cannot make a car without headlamps of a certain brightness or brakes and tires that pass strict tests. Windshield and window glass must not shatter into deadly shards, airbags must inflate, and seatbelts have to be a certain strength. New car designs have to pass impact and rollover tests, fuel economy tests, visibility tests, crash tests, crush tests, and dozens of others. Even the stick shift knob must be large enough not to penetrate the human optical orbit, a lesson learned after some number of brains got skewered. All of which helps explain why traffic fatalities are lower now than at any time since 1950: only 35,000 Americans died on the road that year—the same as in 2009. (Contrast this with the growth of smoking deaths from about 100,000 to more than 400,000 during this same time frame.) Every stretch of highway, like every car, is a physical expression of hundreds of safety and performance standards, which don’t strike us as prohibitions only because we don’t generally see what is not, and indeed by law cannot, be built. Vehicles, roads, and signs not up to snuff are effectively banned.
Otherwise put: we live in a world of ubiquitous prohibitions. Government-financed institutions establish standards for air, food, and water quality, along with the health and safety of work, the safety of transportation, standards at schools and hospitals, and limits on how, when, or what we hunt or fish. And how we hire or fire workers or trade stock or treat children. These all involve prohibitions, safeguards against threats to one or another aspect of human life and freedom.
My point is not that these are perfect institutions or even that they are doing a satisfactory job; there is always room for improvement. The point is rather that many of our freedoms depend on limits on takings, along with punishments for the negligent. We also live in a world where loud libertarian ideologues try to make it sound as if regulation is inherently a bad thing, the enemy of freedom, when the fact is that every family vacation completed safely on a highway, every airbag inflated properly during a crash, every airplane landed safely with the aid of an air traffic controller, every life saved by a shear-bolt breakaway sign post, every antibiotic not fouled by a charlatan, every doctor with a medical license, every house built in compliance with an electrical code, is proof of the value of standards properly enforced. I would also suggest that anyone with a knee-jerk objection to “prohibition” canvas some of the 500,000 hits returned from a Google search of “laws prohibiting”; I suspect that most of these are things that few people would like to see overturned.3
Safety of course is not the only rationale for prohibitions. Performance-enhancing drugs and gear are barred from many sports, to ensure fairness and the integrity of competition. Many environmental laws entail prohibitions—on hunting certain animals or improper discharge of wastes, for example—often with the goal of protecting air or water quality but also to preserve our ability to appreciate nature’s untamed splendor. Pesticides are sometimes banned to protect endangered wildlife, and heritage laws prohibit destruction of natural monuments or historical artifacts. Sustainability is sometimes the goal, as when Irish fishermen organized to prohibit mechanized trawling in Northern Ireland’s Lough Neagh, home to the tastiest eels in all of Europe. Trawling in the 1950s and 1960s had led to a dramatic fall in the catch, so a decision was made to allow only line fishing and draft nets—no trawling. Eel populations have rebounded as a result, and local fisher folk have preserved their livelihood based on this prohibition—along with a host of other sustainable management practices.4
So we already live in a world of routine if invisible prohibitions, established to protect the weak from the powerful, the innocent from the abuser, the prudent from the greedy, the public from the polluter. Prohibitions of this sort may often go unnoticed, rendered invisible by the absence of the barred artifact from consumption or circulation. Further clouding our perception is the rancor of libertarians, who denounce all “intrusions” by “the government” as onerous. This man-alone-on-anisland myopia makes it hard to keep in mind the myriad bans from which most of us benefit every day. Insofar as we live in a world of freedoms preserved through laws, prudent prohibitions are a crucial part of this.
The cigarette is the deadliest artifact in the history of human civilization. It is also a defective product. The cigarette is the seatbeltless car, the lead-painted crib, the car with faulty brakes, the open unguarded manhole, the rickety ladder, the fouled maggoty meat, the Dalkon shield, the smokestack spewing fumes. It is lead paint and asbestos and arsenic and worse, since it kills so many more and so slowly and seductively. And it is still, apparently, the only consumer product that kills when used as directed. Half its users, in fact.
There will come a time, I am convinced, when tobacco will no longer be widely smoked, and people will marvel at this odd obsession of the past. And historians will puzzle over how and why nicotine captured as many people as it did, and for so long. The change won’t come about overnight, and for a time we can expect the industry to continue bullying and buying off its critics. Change in some parts of the world will come from grassroots movements, with local policies quilting into ever larger policies. Elsewhere change will come from the reasoned actions of elected officials, acting under pressure from an informed and outraged public. Smoking will persist in parts of the world for many years, but tobacco will one day become part of a closed chapter of history. Cigarettes will join lead paint and ubiquitous asbestos and other abandoned artifacts—like the spittoon or buggy whip—and this chapter of history will come to an end.
To bring this about, though, we need to keep our eyes on the prize. Cigarettes are the world’s most widely abused drug and the world’s largest preventable cause of death and suffering. We are talking about the bane of a billion living smokers and an unparalleled corruption of science and the human lung. A destroyer of forests and the world’s leading cause of fires. A cause of global impoverishment and global disease—and a burden abhorred even by smokers. To reclaim clean air for the commons, and to prevent needless suffering, including millions of those not yet born, the manufacture and sale of cigarettes must be abolished.