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Yet the NCI monograph was portrayed by the press as debunking the "myth" that cigars are safer than cigarettes. How come?
Well, the monograph itself implicitly criticized cigar enthusiasts for suggesting that an occasional cigar is no big deal, even though the data it presented tended to support that view. The NCI called the recent increase in cigar smoking "disturbing" and "alarming," and it downplayed the differences between cigars and cigarettes. "Cigars are not safe alternatives to cigarettes," said NCI Director Richard Klausner, neatly skirting the issue.
That kind of obfuscation–similar to the line on smokeless tobacco–has been repeated again and again by public health officials. An article on cigars that appeared in The New York Times last year quoted Michael Eriksen, director of the CDC’s Office on Smoking and Health. This is what he had to say about the hazards of cigars: "Tobacco is tobacco is tobacco." The Times itself went further, incorrectly asserting that cigars pose "higher risks than...cigarettes." Last February, the NCI’s Donald Shopland told USA Today, "You’re smoking a whole pack of cigarettes when you smoke a cigar."
Shopland’s estimate is two and a half packs shy of the figure preferred by California officials. A TV ad sponsored by the California Department of Health Services shows a cigar in a man’s mouth morphing into 70 cigarettes, the number that, according to the narrator, "you’d need to equal the nicotine in that big fat stogie."
The comparison is misleading even in terms of nicotine delivery. According to the NCI monograph, a typical premium cigar yields about as much nicotine as a dozen cigarettes, not 70. The 70-to-1 ratio is also bound to encourage erroneous conclusions about the relative health risks of cigars. According to The Sacramento Bee, the ad "points out that smoking cigars poses the same health risks as smoking cigarettes." The Los Angeles Times described the ad as "comparing the effects of one cigar to smoking the equivalent of 70 cigarettes."
As with propaganda about illegal drugs, such scare tactics have the potential to backfire. After seeing the California ad, someone who smokes a couple of cigars a week might conclude that he would be no worse off smoking a pack of cigarettes a day. Alternatively, someone who realized how deceptive the ad was might be inclined to dismiss future warnings from public health agencies.
Aside from education, the policy prescriptions offered by public health specialists sound quite different from those offered by drug warriors. Prohibitionists emphasize interdiction, crop eradication, and other attempts to reduce the supply of drugs, along with arrests, fines, property forfeiture, and imprisonment for producers, sellers, and buyers. Public health specialists emphasize treatment, taxes, and regulations.
Both sets of policies are aimed, in part, at deterring certain kinds of drug use by making them more expensive and less convenient. While the public health prescriptions certainly seem milder, their effects can be similar. Voluntary treatment, for example, is clearly preferable to incarceration, but many advocates of drug treatment would send uncooperative "patients" to jail. In her recent history of drug use in America, the journalist Jill Jonnes explains the rationale for coercive drug treatment: "It is well known in the drug world that most addicts will not seek treatment except under some sort of duress," she writes. "Nor, for the most part, will they stick with it unless forced."
This attitude is encouraged by the disease metaphor that is central to the public health model. A disease is something inherently undesirable that happens to people against their will. No one in his right mind wants to be sick. Furthermore, this is a disease that is said to impair the patient’s judgment; one of its symptoms is "denial." Where’s the harm, then, in forcing an addict to be well? Under the circumstances, this would seem the compassionate thing to do.
Just as treatment can resemble prison, taxation can resemble prohibition. Prohibition itself can be viewed as a tax, raising the prices of certain goods by making them riskier to produce and sell. Conversely, a high enough tax produces some of the dramatic side effects associated with prohibition.
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." If the price of cigarettes goes up dramatically in this country, whether through legislation or as a result of liability settlements, we can expect to see an increase in black market activity, though the magnitude of the problem is a matter of dispute.
Regulations, too, can simulate the effects of prohibition by restricting information, discouraging innovation, and banning the sale of products that people want to buy. The FDA, for example, has seriously considered requiring the tobacco companies to gradually eliminate nicotine from cigarettes. Such a policy would not only invite a black market in full-strength cigarettes, it would actually increase the hazards faced by current smokers, who would tend to smoke more to compensate for the reduction in nicotine. Remarkably, this proposal has been suggested by some of the same people who note that nicotine compensation undermines the health advantages of low-yield cigarettes.
Which raises the issue of safer cigarettes. Cigarette 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 measure of what smokers actually absorb–the evidence suggests that cigarettes today are significantly less hazardous than they were in 1950, even allowing for compensatory behavior. 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.