Cigarettes

Harm-Reduction Initiatives Violate Hippocratic Oath

California propositions deal with cigarette taxes and condoms in pornos.

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Most of us have heard the dictum, "First, do no harm." It's often thought of as part of the Hippocratic Oath—the traditional oath that new physicians take, in which they pledge to uphold the finest traditions of medical practice.

Those precise words don't actually appear in the oath, but they were penned by the Greek physician Hippocrates in another work. The advice is pretty clear—physicians should never do more harm than good.

Such lofty ideals don't usually work their way into debates about California state ballot initiatives, but this year, two of the more prominent measures are based on the simple idea of "harm reduction." Proposition 56 increases the state's relatively low tobacco tax by $2 a pack of cigarettes (and equivalent amounts for other nicotine products). Proposition 60 requires actors in pornographic films to use condoms during sexual intercourse.

The key promise behind Proposition 56 is that higher taxes will discourage people from smoking cigarettes, which unquestionably are dangerous products. The foundation of Proposition 60 is that adult-movie actors are at-risk of becoming infected by various sexually transmitted diseases such as HIV and hepatitis B. Condoms are known to limit such harm. So on the surface, at least, these measures seem to advance legitimate harm-reduction goals.

As with all initiatives and legislation, one needs to look closely at the actual language to see if it lives up to the lofty promises. In both cases, the initiatives clearly do more harm than good. For instance, Proposition 56 dramatically increases the rate of taxation on e-cigarettes and other vaping products. Public Health England, as well as studies in the United States, find that vaping is not totally safe, but is 95 percent safer than cigarette smoking.

If Proposition 56 supporters' premise holds true, higher taxes discourage the use of such products. That means the initiative would discourage the use of cigarettes—but would also reduce the use of much-safer e-cigarettes. Those e-cigarettes have been shown to be an effective tobacco-cessation device used by smokers trying to break their habit.

Proposition 56 has other problems, too. It is mainly a money grab by those seeking additional reimbursements through the Medi-Cal system, which provides health care for poor Californians. But from a "do no harm" standpoint, the e-cigarette tax hike is the measure's biggest flaw.

As the nonpartisan Legislative Analyst explains, under Proposition 60 "any California resident could request Cal/OSHA to address some alleged adult film workplace health and safety violations. If Cal/OSHA does not take certain actions within specific time frames, that person could file a civil action against the adult film producer."

As the Los Angeles Times opined, "The proposition would, in effect, make every Californian a potential condom cop by both mandating condom use and creating a private right of action so that any resident who spots a violation in a pornographic film shot in the state could sue and collect cash from the producers and purveyors if they prevail in court. … There's also the possibility that some people might use the new law to harass adult-film performers." In rare unity, the Democratic and Republican parties have come out against it.

Those provisions are harmful in a different way than, say, a venereal disease. But Proposition 60 could prove to be a terrible measure from a health perspective, also. The heart of the adult-film industry is in the San Fernando Valley, most of which is part of the City of Los Angeles. That city already passed a less-onerous condom requirement in 2014. The net result: The initiative could send what remains of the adult-film industry to Nevada, which has fewer health requirements for these actors. Others fear it would send the industry underground, where there are no requirements at all.

This November, California's ballot has 17 statewide initiatives, many of them complex and significant. Voters will typically read the short titles and summaries and make their decision. Based on a cursory look, both Propositions 56 and 60 promise to reduce harm—and might therefore look appealing to voters. But a more detailed look shows that instead of improving public health, they do much harm.

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83 responses to “Harm-Reduction Initiatives Violate Hippocratic Oath

  1. “Stop it! Remember your hippopotamus oath!”

    Prop 60 is terrible. And I’ve had to tell my mother not to go to the Out of the Closet thrift store any longer because it benefits AIDS Healthcare Foundation, who’s behind Prop 60.

    1. I’m pretty sure the hippopotamus oath is found by calculating a2 + b2 = c2 .

      1. The sqrls stole my superscript!

        1. That’s what’s sup.

  2. The willfully ignorant hypocrisy of do-gooders never ceases to amaze me. They don’t give a shit that their cigarette tax has the drawback of making it harder for people to quite smoking. Probably because they see smokers as losers, sinners, sorry-ass weaklings who deserve to suffer if they can’t quit cold turkey, or, even worse, as people who intentionally want to enjoy something which disgusts the do-gooders.

    1. I know. We have a concrete example of how stupid prohibition is yet there they are. Like a bunch of baboons still thinking they can manage virtues and vices.

    2. Sadism is one of the motivations behind puritanism, but ultimately it is about power over others. With this law every bluenose busybody that votes it in will have the satisfaction of knowing they tormented a dirty smoker and looted them of their money. If more smokers die because it is more difficult to quit smoking, good riddance to them.

      Remember – Foreseeable consequences are not unintended.

      1. That reminds me of the old BDSM joke:

        Masochist: “Hurt me baby!”
        Sadist: “No”

    3. My biggest complaint regard Prop 56 is that it’s class-based law making, where wealthier people are less affected by the law. Targeting specific products for taxing both violates the free market and circumvents the rule of law insofar as it creates a de facto law where money grants special privilege.

    4. They don’t give a shit that their cigarette tax has the drawback of making it harder for people to quite smoking.

      Drawback? If ecigs were exempt from the tax smokers might switch to them, and tobacco tax receipts would drop. Discouraging smoking is the excuse for tobacco taxes. If you want to know the real reason, follow the $.

  3. Looking through the CA props, first glance says the ones to approve are:

    53 (adds more restrictions on how the legislature can raise revenue)

    54 (requires the legislature to post session videos within 24 hours and not vote until 4 days after posting the text of bills to the internet)

    62 (seems to abandon the death penalty because it’s immoral and wastes a lot of money on useless appeals)

    64 (recreational pot; sucks, but better than the current criminal scheme)

    I have questions about two:

    57 (prison reform) Lots of nice stuff about rehabilitation, shifting the decision to try juveniles as adults to judges from prosecutors. But there’s a lot of stuff in there which may have other effects.

    58 (lots of stuff about teaching in English) I can’t tell offhand whether it intends to establish English as the only valid teaching language or what.

    Anybody know more about 57 and 58?

    1. As regards 58, I would apply the basic test of any education bill; do the Teachers’ Unions support it? If so, it’s almost certainly tripe. Do they oppose? Then it’s certainly woth a closer look.

      1. That’s always been a basic test, along with — is it a new law? Then no, unless it replaces more law with less law. Does it spend money? Then no, unless it spends less than what it replaces.

        There are always exceptions.

        But in this case, no luck, since the downloaded PDF is just the vare text of the initiatives, with strike through, bold, etc. No legislative analyst, no pro/con, no backers/opponents, etc.

  4. Steven Greenhut & Damon Jacobs, you may want to check how few medical schools administer the oath and how drastically it’s altered by the few that do administer it.

    1. What would be the point? The Hippocratic oath is barely mentioned in the article. The headline is misleading.

      In any event, hardly anyone swears the Hippocratic oath anymore because the original text sounds silly today and contains lines that most physicians would find objectionable or that aren’t practical today. I’m not swearing to give my medical school teachers money if they need it, nor am I going to teach their families medicine for free. No urologist would agree to not perform procedures to eliminate kidney stones. Finally, I don’t give a damn about a whole bunch of Greek gods.

      The elimination of the Hippocratic oath isn’t some conspiracy. It’s a relic of a long gone era of medicine, part of tradition, but no longer really relevant. Almost all medical schools use some form of oath and most call it a Hippocratic oath because if they didn’t they’d have to answer endless “what about the Hippocratic oath” questions from parents and friends of graduates.

      1. One could equally invoke Pareto efficiency. But that would be far less dramatic.

  5. Following up on a post about Archbishop Blaise Cupich of Chicago (currently being elevated to the Cardinalate) and his views on libertarianism –

    Here is what he said about libertarianism in 2014

    Here is an Acton Institute rebuttal (the Acton Institute is a Catholic organization which supports economic liberty) –

    “I don’t expect bishops to have PhDs in economics, but some appreciation of the new opportunities provided by free markets would be very much welcomed by those of us who want to see growing economies lift people out of poverty. Would it be so bad to hear a bishop say that onerous levels of taxes and regulations make poverty more, rather than less, likely? Would it be impossible for a bishop to say that the freedom to buy and sell licit goods and services doesn’t mean we have the freedom to beat our wives or exploit each other sexually? Would it be that hard to convince their flock that they can run successful businesses without endangering their eternal souls?”.

    1. Of course, some of this critique from Archbishop Cupich looks like a straw man:

      “For Francis the human person seeks and claims an integral development, morally, spiritually and emotionally, which is joined intrinsically to the communities that sustain him. For the Pope’s critics, the human person is the autonomous individual, man the producer and man the consumer.

      “For Francis inclusion and economic security for all are measures of economic health in contrast to the one-dimensional measure of economic growth proposed by his critics for decision making in the growing age of globalization.

      “For Francis, politics seeks the common good. For his libertarian critics, politics seeks to maximize the freedom of markets and individual choice.

      “For Francis the strength of globalization leads to the need for global structures that help mold the forces of market capitalism to advance solidarity and dignity for all. For libertarians market forces left to themselves are the best arbiters of economic progress.

      “Secondly, the Cardinal also draws attention to the unique contribution Pope Francis makes to Catholic Social Teaching by using as his starting point real life experience rather than competing ideas.”

      1. 1) Integral development, communities, etc., flourish better under freedom than under arbitrary government.

        2) Economic growth does tend to lift all boats, and a moderate program of social welfare can put the excluded back on their feet – or if they’re disabled, keep them from pauperism – without yielding to arbitrary government.

        3) The common good is best promoted in a climate of freedom.

        4) “global structures” run by the U.S. or the U.N. don’t really have the best record vis-a-vis the market.

        5) question-begging

        1. The fun part is that if progressive prelates argue against economic freedom via the straw-man strategy, then faithful Catholics can disavow the straw-man positions while still holding firm for economic liberty.

          “I denounce all those people (if any there be) who say that human beings are mere producers and consumers, that politics isn’t about the common good, that economic growth is separate from inclusion and economic security, etc.”

          1. Said Ripley to the andriod bishop.

          2. It is important to recognize in fairness that many libertarians share with Catholic Social Teaching a respect for human dignity. Human dignity anchors their insistence on human freedom. They rightly argue that this dignity is not given by society but by the Creator and therefore freedom, self-determination and all other human rights are inalienable, echoing the principals in the documents of democracy. However……

            Aaaaand, we’re off the rails.

            1. Someone should explain the But Rule to them, and the pope has no small part in the origin of that rule. Maybe we should start by explaining the joke about the chicken’s tail first.

          3. I am not going to slog my way through all of that.

            I got this far: “For Francis, politics seeks the common good. For his libertarian critics, politics seeks to maximize the freedom of markets and individual choice.”

            Fuck the idiot commie pope. And fuck the cardinals for electing him.

    1. By definition he did!

      Bush’s wars were unilateralist, arrogant, lacking in nuance.

      Obama’s wars are nuanced, complex, evidence-based, kinetic.

      See the difference?

      1. Black privilege?

    2. My friend insists on repeating he’s ‘fixing a mess’ and has done pretty good.

      All I see is a foreign policy in tatters and an economy in recession.

      Apparently he’s FDR too.

      It’s defies logic.

      1. Haha. Are you shittn me? I don’t hear anyone under 40 talking about Syria and most over 40 don’t really know what is going on but remember Vietnam.

        After Obama drops atomic bombs before Trump assumes the Presidency, he can be like Truman too.

        When I mention that most of the USA is still in the Great Recession, people actually say that the government says we are not.

        As you say, it defies logic.

        1. I swear, most of my proggie family members don’t even realize we’re still fighting over there. If NPR doesn’t cover it, it doesn’t exist.

          We’re close to another financial meltdown. People pretending everything is just ducky is simply whistling past the graveyard. The last ten years sucked, but I think deep down most people realize that it can and likely will be worse.

          1. most people realize that it can and likely will be worse

            Then this election season proves that America has a darker sense of humor than I had imagined.

          2. “Oh. The markets are up! Good enough for me! Thanks Obama!”

            Bah-bah-bah…

          3. I hear ya.

            I comment on Ars Technica sometimes and they did an article on Mylan’s Epi-Pen. I laughed because I made a grip on buying low and selling high twice because I saw that they were cornering the market on epinephrine and the FDA was helping them.

            The prog’s heads exploded with hate but refused to put any blame on the FDA.

            After making a quick buck, I pull my money because the market could tank again at any minute. Most people have now clue that most of the USA is still in the Great recession.

        2. Even if you get them to open their fucken eyes and expand their brain they will simply counter with ‘yeah well, he tried but GOP obstructionism and racism…”

          His legacy is set in their eyes.

          1. Oh, his legacy is set alright.

  6. Do We Really Want War With Russia?

    It’s a bit over-the-top, but the bit about the NYT cheerleading intervention in Syria makes me wonder, if Hillary wins will we have another Middle Eastern war?

    It seems like, if my young adult life is any guide, there is minimal anti-war sentiment during a Democratic administration.

    1. Democrats tend to be war mongers. Most wars in American history were started by Democrats. Truman (Democrat) is credited with the only use of atom bombs on another country. Not to say that the USA should not have fought certain wars and used the atomic bombs on Japan.
      http://retiary.org/misc_pages/….._wars.html

      Russia has moved AA missiles into Syria and has threatened to shoot down US aircraft. What happens if they shoot down and kill and American pilot? Americans will want war. Syria is a dangerous game and America has to decide if its worth it.

      Russia is unstable politically as Putin depends on Nationalistic prowess to keep power. Plus, it is politically appealing to Russian to restore Mother Russia, including the Crimea, Finland, Ukraine, Belarus, the Baltic States, etc. Most Americans do not understand Russia or Putin. Putin is ex-KGB and he is testing to see how much he can get away with.

      1. I’m ok with Russia taking back the Baltic states, Syria, and everything north of Richmond.

        1. Everything north of Taneytown.

      2. I wonder what Putin would think about Trump’s “grab them by the pussy” tapes.

        1. He’d say, “I carry them like a bowling ball”.

        2. Putin would talk about grabbing 2, 3 or 4 pussies at a time.

  7. The bottom line is that taxes increases should just be voted against every time. Until we get federal and spendthrift states budgets reduced by 50%+, just stop giving these politicians more money.

    As to sin taxes, they should just be voted against on principle. Its all fun and games until sooner or later the government will want to increase a tax on something you do like.

    The condom in porn thing is just a guaranteed way to get porn to move their entire operation outside Taxifornia. If that is one thing Taxifornia can afford to do is lose more jobs. Brilliant!

    1. most of the mammal mating videos I have watched recently appear to be filmed in Miami

      1. I would think most of the reptile mating videos as well. Miami’s climate is well suited for that.

  8. There’s also the possibility that some people might use the new law to harass adult-film performers.

    AND THAT’S LAW ENFORCEMENT’S JOB.

    I don’t understand the pushback against the condom law. If something is banned, it’s banned. There are no other consequences to banning something other than it no longer exists. You ban guns? They’re gone. You ban drugs? No more drugs. You ban bareback? Prophylactics on every penis. Isn’t this what we all want?

    1. Prophylactics on every penis. Isn’t this what we all want?

      No?

      1. Prophylactics on every penis. Isn’t this what we all want?

        I’m guessing you will see a lot of bounce blow back from the nuts if they try to enact this.

        1. I just don’t want to see someone get shitty all over the condom thing.

        2. This condom thing is really gonna get messy before its all over.

    2. How can you support this, Fist? As a libertarian shouldn’t you be opposed to any and all barriers to entry?

    3. You see, it starts with everyone must have access to birth control. Then, they start to mandate it’s use. That which is not mandatory is forbidden.

  9. The key promise behind Proposition 56 is that higher taxes will discourage people from smoking cigarettes

    Bullshit. That may be what they say, but the actual goal is to extract more money from a compliant crowd. It’s they same reason hotel taxes are outrageous – because they can be.

    1. Yes, they pay lip service to the supply and demand curves when it helps pass a sin tax or tariff, but pretend it doesn’t exist when it comes to wage and price controls.

    2. Hotel taxes are a real scam and have gotten out of control because the people they impact are not votes in the state. The impact is always felt sooner or later because tourists just stop coming or they don’t fly into your airport because they get hit with airport taxes, rental car taxes, hotel taxes, food taxes, plastic bag taxes, etc.

      Just think about how many times your wealth is taxed again and again and it should infuriate you.

      1. Yeah, rental car and hotel taxes are the favorite way of pols to fuck over people who can’t vote them out.

        I would love to see the relationship between hotel and rental car taxes and new stadiums. In Minnesoda that was the preferred way to build the Vikes a new playground. Until Gov. Mumbles came up with electronic pull tabs.

    3. I thought the primary goal was to create a black market in cigarettes. Foolish me.

      1. You are brave to get choked to death for a loosie. That black market for cigs is dangggggeeeerrrrooouussss.

  10. OT (a bit):

    Have we found a good judge?

    Five minutes before Michael Delgado’s alarm was set to go off last November, flash bang grenades shattered the windows to his north Minneapolis home. Eighteen Hennepin County officials dressed in riot gear and carrying semi-automatic rifles stormed inside searching for drugs. Another 10 to 14 stood guard outside as an armored truck equipped with a sniper focused on the house.

    That search, Hennepin County District Judge Tanya Bransford ruled, was unconstitutional. She wrote that the “military style” tactics were a violation of the Fourth Amendment protection against unreasonable searches and seizures.

    She was “troubled,” she wrote, “that the types of militarized actions used in this case seem to be a matter of customary business practice” for Hennepin’s drug task force squad, known as the Emergency Services Unit (ESU).

    1. The reason I put a question mark in the link is because it was this same judge who signed the no knock warrant in the first place. She claimed she didn’t know that there would be 32 cops involved in the search when she signed it.

      So maybe she had her road to Damascus moment. Or maybe the victim of the search was connected somehow.

      1. She claimed she didn’t know that there would be 32 cops involved in the search when she signed it.

        I don’t find that the least bit improbable – she probably didn’t know anything at all about the warrant application. Her job’s just to sign ’em, they don’t read ’em.

        1. Is that part of a warrant application even? I’d have figured it just covered the who/why for the warrant, not the how.

          Do I even jackboot, broh?!

    2. No, that’s a bad judge:

      The officer wasn’t actually after the 30-year-old, but another man staying at his home, Walter Power, who was suspected of selling marijuana.

      But because Delgado had a registered firearm and was licensed to carry, Bransford signed off on an application for “no-knock” search warrant to enter a home unannounced.

      The homeowner has no criminal record, wasn’t suspected of committing any crime yet she approves a “no knock” warrant on his abode because a guest was suspected of having sold a little weed?

      1. But because Delgado had a registered firearm and was licensed to carry, Bransford signed off on an application for “no-knock” search warrant to enter a home unannounced.

        This makes no fucking sense. Why would you justify a no-knock warrant on the basis of legal firearm ownership? So you’re going to storm into a lawful gun owner’s home unannounced? That’s just asking to get shot by the homeowner, who would by any objective standard be acting in self-defense.

        No, if you are dealing with a legal gun owner, you knock.

        It only makes sense if the end goal is confiscation. Rush in, grab the guns, and hope your trigger finger is faster than his. Those aren’t the tactics of Peelian police. They’re the tactics of a gestapo.

        1. It makes sense if the end goal is to maximize death. So few people realize that the first ten chapters of Atlas Shrugged were being written while God’s Own National Socialists were “just following orders” and stretching ropes in Nuremberg. The Author was married the year Herbert Clark Hoover unleashed death squads to murder men. women and children and tap their phones for the felony of selling light beer. Yet Ayn’s argument that love of death/hatred of life is what impels altruists to pull government guns and make examples of all who are less than quick to follow orders.
          In that same book, the the men from Galt’s Gulch who quietly surrounded the government building were in direct disobedience of Kristallnacht gun laws.

      2. But because Delgado had a registered firearm and was licensed to carry, Bransford signed off on an application for “no-knock” search warrant to enter a home unannounced.

        This makes no fucking sense. Why would you justify a no-knock warrant on the basis of legal firearm ownership? So you’re going to storm into a lawful gun owner’s home unannounced? That’s just asking to get shot by the homeowner, who would by any objective standard be acting in self-defense.

        No, if you are dealing with a legal gun owner, you knock.

        It only makes sense if the end goal is confiscation. Rush in, grab the guns, and hope your trigger finger is faster than his. Those aren’t the tactics of Peelian police. They’re the tactics of a gestapo.

        1. The tactics of The Kleptocracy… and of their infiltrators among the Reason staff, work in mysterious ways. To hear Gary denounced for insufficient zearl in “religious freedom”–murdering potheads, asset forfeiture and forcing girls to bear their rapists’ offspring is by itself enough to explain how they justify sending Hitlerjugend with guns in to kill homeowners whose Second Amendment rights “endanger the state or violate the ethical and moral feelings of the Germanic race.”
          It’s all in the premises…

    1. No pussy grabber there.

      Ass grabb’n though….

    2. Maybe he isn’t sure about grabbing one because he read cautionary tale.

      1. Pussy can be fickle. The butthole is always just an asshole.

  11. Morel like Hypocritic Oath, amirite?

  12. The porn industry could move to Utah, produce tender, romantic plural-marriage epics in spouse-swapping Church backgrounds and bring back the better parts of That Old-Time Religion. After a XXX version of “Stranger in a Strange Land” it should be a simple matter to replace the Kleptocracy televangelists in Landover Baptist California, repeal their meddlesome law, their state income tax, their econazi enviroregs, dot the coast with nuclear reactors and ABM systems.

    1. They already have some classic Mormon porn.

      Family Tithings, 80 is enough, 3x3x3’s Company, MormonGirlzHD, etc.

  13. “One needs to look closely at the actual language to see if it lives up to the lofty promises [ harm reduction ].”

    Actually one doesn’t. Taking away one’s right to do as one pleases with one’s body, or with a willing partner’s body, is fundamental to freedom. I don’t have to look at whether the alleged health effects are present. That is irrelevant. Therefore the propositions do more harm than good.

  14. “cigarettes, which unquestionably are dangerous products.”

    No, they are unquestionably UNHEALTHY products. I have never smoked a single cigarette in my life, but God do I hate how so much of the fanatical anti smoking propagandists’ language and views have become mainstream, even from those that don’t want it banned.

  15. You know what else violates the Hippocratic Oath? Doing any kind of surgery.

    “I will not use the knife, not even, verily, on sufferers from stone,…”

    In Hippocrates’ time, surgical operations were done by barbers.

  16. It was my understanding that the term “Harm Reduction” has come to represent a very specific approach to reducing the harm associated with drug use. Ive seen the term attached to efforts to institute needle exchange programs, condom handouts, provide free TB testing & education on how to bleach syringes & safely inject. Ive also seen the term used to argue in favor of drug legalization efforts. I have never heard of the term being associated with increased regulation or direct tax efforts. In fact the opposite is true – ie higher costs for drugs lead to higher likelihood of theft and less access to healthcare. I have heard of harm reduction used much more rarely in relation to tobacco use but only with noncompulsory efforts – ie allowing easy access to vaping is a harm reduction measure.

    Perhaps I misread but I didnt see anyone citing the two ballot measures covered here as harm reduction measures other than the authors. Doing so muddles an already deeply misunderstood approach to public healthcare that is unique in both its respect for human liberty and its incredible efficacy in reducing communicable disease infection rates in the small but growing number of cities where harm reduction initiatives are adopted. Harm reduction advocates have even been targetted for federal prosecution (google cold water extraction website prosecutions) and are not the friends of state nannyism the article.makes them out to be.

  17. I wonder, where does cutting off a man-who-believes-they’re-a-lady’s penis fall on the ‘do no harm’ rubric? Is it a net benefit, or a net harm? I honestly don’t know myself, but when one considers the suicide rate for post-op it does make me wonder. Is a person sane enough to make their own surgical decisions when this is what they decide? I for one don’t know for sure, I’m not trained. From the outside looking in, I would tend to lean towards ‘no’.

    I only bring it up because it seems to me that the vaping and smoking measure is a matter of law, which therefore doesn’t fall anywhere close to the Hippocratic oath; the above issue certainly would and might make a more interesting topic. So I bring it up to illustrate why the entire headline and article are essentially bullshit. Sorry, Greenhut & Jacobs, but your clickbait misleading headline is rude. Not that it’s a bad story necessarily, but what the actual fuck does a Doctor’s oath have to do with California lawmaking? Are there even any M.D.’s in California’s legislature? Don’t answer that. I don’t care.

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