In a position paper defending its proposal for a health insurance surcharge on smokers in order to raise needed revenue for health care reform, Action on Smoking and Health (ASH) has argued that in contrast to the arguments being made by plaintiffs in thousands of tobacco lawsuits, including the Engle progeny cases, smoking is a personal choice which represents a behavior and not an addiction.
According to ASH, smoking is a choice and not an addiction. Smokers make a free and conscious choice to smoke and their behavior should not be viewed as addictive. The only aspect of their addiction - says ASH - is the addiction to nicotine, and smokers who continue to smoke are making a deliberate and free choice to obtain nicotine from cigarettes rather than from nicotine replacement products that are available on the market.
Specifically, ASH argues that "most people see buying and using cigarettes as a habit or a choice, thus fitting the criteria for a user fee. Although there is evidence that for many people smoking involves addiction, the addiction is to the drug nicotine, not to the act of smoking itself, which is a behavior. Because those who desire to can easily ingest nicotine from nicotine gum, nicotine patches, nicotine spray, and nicotine inhalers, their decision to ingest it by smoking rather than by using nicotine replacement products is a choice. Since it is a choice rather than an addiction, disease, or health status, it is fairer to impose personal responsibility for the choice by making smokers bear at least a small portion of the huge costs their choice imposes on the economy and the health care system."
The Rest of the Story
In one fell swoop, ASH has destroyed the argument necessary for plaintiffs to prevail in tobacco litigation. In order for juries to find tobacco companies partly responsible for the health damages suffered by smokers, those juries must be convinced that the decision to smoke was not a free and informed choice, but that instead, smoking is highly addictive and thus smokers, to some extent, were not free to simply decide not to smoke.
I find it ironic and very unfortunate that ASH - the group which helped pioneer these lawsuits against the tobacco companies in the first place - has now destroyed the very basis for this litigation by arguing that smoking is not an addiction, but instead, is a free and informed choice.
Specifically, ASH has argued that in making the decision to smoke, smokers have made an informed decision not to use nicotine replacement products to satisfy their nicotine addiction, but instead, to rely upon the continued use of cigarettes to satisfy their need for nicotine.
It is terribly ironic that ASH is now making precisely the same argument that the tobacco company defendants have been making in the courtroom: that smoking is a choice, not an addiction.
If I were representing the tobacco companies, I would introduce ASH's statement as evidence in every tobacco trial I was litigating to demonstrate to the jury that even among anti-smoking advocacy groups, smoking is viewed as a choice and not as an addiction. This would be extremely damaging to the plaintiffs in these cases, who need to convince the jury that they were addicted to smoking.
As an expert witness in many tobacco cases, including the Engle case, I can tell you that a key aspect of these trials - one which I addressed in great detail in my testimony - is the issue of whether or not the smokers in question were addicted, or whether they were merely smoking by choice. In fact, this is the central issue in these cases, and the way in which the juries view this issue is essentially dispositive of the outcome of the case.
Why has ASH given up this kind of ground to the tobacco companies? Because they boxed themselves into a corner by promoting such extreme policies - like calling smoking child abuse and arguing for isolated surcharges on smokers - that in order to defend these ridiculous proposals, they had to abandon their historical argument that smoking is addictive and switch over to the tobacco industry's position.
I find it quite unfortunate that ASH switched over to the tobacco industry position simply because it boxed itself into a corner by virtue of an untenable policy position. In doing this, ASH is - I believe - undoing much of the great work it has done in promoting justice for smokers fighting the tobacco companies.
Perhaps most unfortunate is the fact that ASH's argument that smoking is not an addiction is an untenable one from a scientific perspective. As I have been arguing for months on this blog (in the context of discussing why electronic cigarettes are so popular), the addictive nature of smoking is not due solely to the pharmacologic effects of nicotine. The behavior itself is part of the addiction.
Research shows that treating the pharmacologic aspect of the addiction is not enough to reduce the craving to smoke, and that replication of the behavioral aspect of smoking, even without any nicotine delivery, can be effective in suppressing the desire to smoke. Thus, ASH is simply wrong when it states that "the addiction is to the drug nicotine, not to the act of smoking itself, which is a behavior."
Despite the pharmacologically-laced and financially-influenced mentality of the anti-smoking movement these days, the act of smoking itself is part of the addiction, not just the pharmacologic and physiologic effects of the nicotine.
The rest of the story is that in its zeal to support oppressive and extreme policies that aim to punish and further marginalize smokers, ASH has backed itself into a corner and been forced to make a scientifically invalid argument that is not only false, but which does damage by destroying the plaintiff's position in thousands of lawsuits against the tobacco companies.