With apparent zeal for trying to further the "cause" of preventing medical care for smokers, former director of Action on Smoking and Health - Professor John Banzhaf - is publicly claiming that smoking is a choice, not an addiction, thus destroying the critical legal basis for thousands of pending lawsuits against the tobacco industry.
In a press release issued yesterday, Professor Banzhaf argues that: "although there is evidence that for many people smoking involves addiction, that addiction is to the drug nicotine, not to the act of smoking itself, which is a behavior. Because those who desire to quit smoking (e.g., for a medical procedure) can ingest nicotine from nicotine gum, nicotine patches, nicotine spray, nicotine inhalers, and e-cigarettes, 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 seems more legally justified to restrict access to medical care to smokers than to the obese."
The Rest of the Story
Professor Banzhaf's statement destroys the most critical aspect of the legal argument in thousands of pending lawsuits by smokers against the tobacco industry: that the smoker was addicted and could not easily have made a choice to quit smoking. Ironically, this is precisely the major defense argument presented by the tobacco industry in every one of these cases.
The tobacco companies should retain Professor Banzhaf as an expert witness in future cases, as his testimony would be devastating to the plaintiffs in these cases. Of course he would not testify in that capacity, but his public statement can certainly be used by tobacco attorneys as evidence that at least some tobacco control experts view smoking as a choice and not an addiction.
It is also ironic that Banzhaf is in many ways the architect behind litigation behind the tobacco companies, as he played a major role in crafting and promoting these cases. It is therefore ironic that he is now, in a single stroke, destroying the major legal basis for this entire field of litigation. Apparently, the zeal to try to prevent medical care for smokers is overwhelming.
The truth is that Professor Banzhaf is wrong on the science. Smoking is an addiction and it is not simply an addiction to nicotine. If it were merely an addiction to nicotine, then nicotine replacement therapy would have a far greater success rate than it does. Addiction to smoking involves both pharmacologic factors (i.e., nicotine) and behavioral factors (e.g., physical stimuli associated with smoking). In fact, one of the reasons why electronic cigarettes are helping many smokers quit who have failed on NRT is that it addresses both the behavioral and pharmacologic aspects of the smoking addiction.
This statement is a bonanza for tobacco companies, as they can use it as a defense in every lawsuit to help convince the jury that the smoker was responsible for his or her own demise.
As far as the effort to deny medical care to smokers goes in the first place, I condemn it. There is no place for this type of bigotry in medical practice. Where smoking is a contraindication to a medical procedure, then of course you would not operate unless the person quits smoking. But it any other case, it is a violation of basic ethical principles of medicine to deny care to an individual because of a personal health behavior decision.