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When the Canadian government sharply increased cigarette taxes in 1989 and 1991, the consequences precipitated a crisis and a dramatic policy reversal. In response to smuggling, violence, and widespread disobedience, the Canadian government announced big tax cuts in February 1994. The solicitor general cited "a frightening growth in criminal activity" and "a breakdown in respect for Canadian law." The prime minister said "smuggling is threatening the safety of our communities and the livelihood of law-abiding merchants. It is a threat to the very fabric of Canadian society."
Regulations, too, can simulate the effects of prohibition by restricting information, discouraging innovation, and banning the sale of products that people want to buy. In the case of cigarettes, manufacturers have dramatically reduced tar yields during the last four decades or so. Although there is considerable dispute about the extent of the benefit--since the official yields are not a very good indicator of what smokers actually absorb--the evidence indicates that cigarettes today are measurably less hazardous than they were in 1950. If the government had stopped the tobacco companies from introducing low-yield brands, or if it had forbidden them to advertise tar yields, we would not have seen this trend.
The next wave of safer cigarettes, represented by the R.J. Reynolds brand Eclipse, promises more-substantial improvements. But an advertising ban or FDA regulation--both of which would make it much more difficult, if not impossible, to introduce new brands--would discourage the development of such products.
The reaction of tobacco's opponents to Eclipse and an earlier RJR attempt at a safer cigarette, Premier, illustrated the tension within the anti-smoking movement between public health and prohibitionism. Representative Henry Waxman, a California Democrat who is one of the tobacco industry's most vociferous critics in Congress, said Eclipse was a positive development. John Pauly, a smoking expert at Roswell Park Cancer Center, said: "We have come to realize that despite numerous warnings since 1964, there exists a very large segment of the smoking population who are either unwilling or unable to give up smoking. It's worthwhile to come in with a safer cigarette."
Other opponents of smoking viewed the new brands with alarm. "We think it's just a desperate attempt on their part to reverse the growing social taboo against smoking," an American Lung Association spokeswoman said of Premier. "It would be too bad to see the current momentum--which has encouraged a lot of people to quit smoking--defused or confused," said Jan Hitchcock, associate director of Harvard's Institute for the Study of Smoking Behavior and Policy. As Matthew Meyers, then staff director of the Coalition on Smoking or Health, explained, "The fact that a product is safer doesn't mean that there is a net health gain if it ends up leading more people to smoke."
Similarly, the physician and addiction specialist John Slade has argued that innovation in cigarette design threatens public health because it encourages people to keep smoking. "If the new products were not available," he wrote in 1990, "more people would be able to respond directly to concerns about illness and death from smoking and become completely abstinent from nicotine." Slade argued that the government should "prohibit any new products unless they first had demonstrated their safety. Had such a policy been in effect in 1950, the only cigarettes on the market today would be unfiltered 70 mm smokes, and far fewer people would be smoking."
Now, it's possible to make a public health case for keeping cigarettes as dangerous as possible. It hinges on the notion, suggested by Myers and Slade, that the health benefits enjoyed by smokers who switch to safer cigarettes are swamped by the health costs associated with people who start or continue smoking because safer cigarettes are available. I'm not sure how you would test this hypothesis, but I find it rather implausible.
In any case, something other than public health seems to be at work here. The opposition to safer cigarettes is reminiscent of the opposition to methadone maintenance and needle exchange programs. In both cases, critics argue that making drug use safer "sends the wrong message." Prohibitionists want drug use to be dangerous, the better to deter the uninitiated and encourage users to quit. Public health specialists, on the other hand, should welcome the opportunity to reduce the harm associated with drug use.
The same sort of conflict can be seen in the reaction to smokeless tobacco. Brad Rodu, an oral pathologist at the University of Alabama at Birmingham, thinks smokers ought to give up tobacco completely. But if they choose not to, he says, they are much better off with smokeless tobacco than with cigarettes.
In his 1995 book For Smokers Only: How Smokeless Tobacco Can Save Your Life, Rodu notes that oral cancer is the only well-established, life-threatening risk associated with the use of smokeless tobacco, and even that disease is twice as common among smokers. He estimates that "if all 46 million smokers used smokeless tobacco instead, the United States would see, at worst, 6,000 deaths from oral cancer [a year], versus the current 419,000 deaths from smoking-related cancers, heart problems, and lung disease."
By this measure, Rodu argues, smokeless tobacco is 98 percent safer than smoking. He and his colleagues estimate that the life expectancy of a smokeless tobacco user is virtually the same as the life expectancy of a nonsmoker. Still, Rodu emphasizes that "smokeless tobacco should only provide a viable and comparatively safe damage control measure for the current and last generation of nicotine addicts."
Rodu, who compares smokeless tobacco to methadone, has been condemned by other opponents of smoking because they consider his message detrimental to the cause. "To say that one form of tobacco is safer than the other at this point in the debate is just irresponsible," said Gregory Connolly, director of the Massachusetts Tobacco Control Program. "Tobacco is tobacco. -- It's like telling someone to jump from the fifth floor instead of the 10th floor."
After Rodu and University of Alabama epidemiologist Philip Cole published a letter in Nature suggesting the benefits of switching from cigarettes to smokeless tobacco, the National Cancer Institute prepared a statement rejecting "the substitution of one known carcinogen for another," which it called "medically and ethically unwarranted." The NCI said recommending a switch to smokeless tobacco "sends the wrong message."
Public health and prohibitionism also clash in the debate over proposals to force the gradual removal of nicotine from cigarettes. As tobacco's opponents themselves have been pointing out for years, people tend to adjust their behavior when they switch to cigarettes with a lower nicotine yield. They consume more cigarettes, take more puffs, inhale more deeply, hold the smoke longer, and so on. This means they absorb more toxins than the official tar yield suggests.
From a public health perspective, then, the last thing you want to do is reduce the nicotine-to-tar ratio. Indeed, what you really want is a low-tar, high-nicotine product. Yet anti-smokers are horrified when a tobacco company tries to maintain nicotine levels while reducing tar, which they see as an insidious plot to keep smokers hooked. In the name of weaning smokers from this habit, they advocate a policy that would make cigarettes more dangerous by forcing people to smoke more for the same effect. This suggests that they are worried about chemical dependence per se rather than the harm associated with it.