A press release issued today by Truth for Healthy Living suggests that a reliance on pharmacotherapy as a smoking cessation strategy may be crippling efforts to help the nation's smokers quit.
Truth for Healthy Living founder, Dr. Richard Lovelace (a licensed clinical social worker), argues that there is so much reliance on the use of nicotine to help people quit smoking that the public health world has lost sight of the possibility that addiction itself is the problem, and not merely nicotine. He questions whether efforts would be more successful if focused on the underlying problem of addiction itself, rather than merely on trying to cover up the effects of nicotine withdrawal.
Moreover, Lovelace asserts, the reason why nicotine replacement has become the mainstay (and a dismally ineffective one) of treatment for smoking cessation is the influence of the pharmaceutical companies, especially their funding of anti-smoking organizations and programs.
Lovelace states: "Accusing tobacco sneakily blames smokers and keeps us from identifying addiction as the root cause of chronic smoking. Why? To take money from unhealthy or at-risk adults and from our children. ... While politically powerful individuals will deny making the wrong decision that now threatens the health of a great many youngsters and adults, addiction specialists may know better. One of them states, 'It'’s a major mistake blaming tobacco for people smoking cigarettes.'"
"Cigarette smokers ... must go without assistance that deals with the root cause of chronic smoking. Nearly all of them are going without. ... Why do addiction professionals who are licensed health care clinicians rarely help adults quit and help prevent teenage smoking when, arguably, they are the most qualified? ... Trained clinicians realize the enormous odds against gaining sufficient attention (little-enough resistance) from present and future '‘users'’ and pivotal support from influential groups so long as credibility is given to focusing on a plant instead of the problem. Don'’t overlook likely profit motives. For instance, accusing the tobacco plant instead of the addicting component legitimizes the making of huge fortunes selling more ways to take in nicotine."
The Rest of the Story
If you can get past a few ridiculous statements in this material (such as tomatoes being a drug and the contention that smokers who garden don't need to buy cigarettes), at its heart I think actually lies a quite reasonable, and possibly, very instructive argument.
If one looks at the various addictive substances and the way in which public health groups deal with them, one is struck by the seemingly obsessive focus in the tobacco control field on nicotine as the sole cause of cigarette addiction and on nicotine replacement products as the single most important and effective solution to this problem.
But the reality is that smoking is a lot more complex a behavior than simply a method of introducing nicotine into the body, and addiction to smoking almost certainly has psychological, and not merely physiological, components. As do virtually all addictive behaviors.
When I worked in a methadone maintenance clinic for two years, I treated patients with nearly every chemical addiction under the sun. And for all of these - with one exception - we provided psychological help: therapy or 12-step programs directed at the underlying roots of addiction. Even when providing methadone maintenance for heroin addicts, And overwhelmingly, the most effective approach to helping clients to actually overcome their addiction was 12-step programs, not merely replacement of the offending drug.
In other words, addiction was viewed as the root of the problem, and we had to deal with that. It wasn't simply an issue of finding out a way to replace the offending drug with one that was less offensive.
But smoking was the exception. Almost uniformly, the approach was to prescribe nicotine replacement therapy and leave it at that. And almost uniformly, the approach failed.
There is little question that nicotine replacement therapy is a dismal failure. While it may be true that it results in a statistically significant increase in treatment success, at least in the short-term, this represents a statistically significant increase over a dismal success rate. As Lovelace astutely points out: "Officials and their agencies give that conflicting, confusing message when suggesting it'’s a way to stop smoking cigarettes. They report or imply that nicotine is now a Food and Drug Administration approved 'medicine' that helps people, to a meaningful extent, quit permanently, when it doesn'’t. Referring to what agencies print when ... using public funds to help sell nicotine delivery methods, someone '‘doubling'’ his or her chances of quitting’ for good means going from little chance to still little chance... ."
Perhaps Dr. Lovelace is correct. Perhaps there is too much of an emphasis on nicotine as the sine qua non of smoking behavior and on nicotine replacement therapy as the sine qua non of smoking cessation interventions.
In fact, I have already expressed my own opinion on this issue, which is quite in agreement with Dr. Lovelace's basic point:
"My own feeling, based on my years of experience in tobacco control, is that pharmacotherapy in general is over-emphasized and that most smokers who quit successfully long-term are those who quit cold turkey without any particular pharmaceutical aids. It is also important to note that smokers who relapse after having tried NRT therapy tend to do dismally in future cessation attempts with NRT. All in all, I think that the benefits and importance of drugs in the smoking cessation process have been over-emphasized."
I have also reported the results of research which casts some doubt on the heavy reliance upon pharmacotherapy in the proposed national smoking cessation action plan. I think it's entirely possible that the putative effects of NRT therapy, if applied on a national level, have been considerably exaggerated and that the ability of the proposed smoking cessation plan to cause five million Americans to quit within one year, as claimed, may be overstated.
I also agree that funding of tobacco control researchers and practitioners by pharmaceutical companies does have a lot to do with the overemphasis on nicotine replacement therapy. As I suggested earlier, the chair of the committee that prepared the national smoking cessation action plan has a rather large conflict of interest in making pharmacotherapy the cornerstone of the plan because he "has served as a consultant, given lectures sponsored by, or has conducted research sponsored by GlaxoSmithKline, Pharmacia, Pfizer, and Sanofi-Synthelabo" and in 1998, he was named to a university chairmanship made possible by an unrestricted gift to his university from GlaxoWellcome."
There is a legitimate argument to be made, I think, that smoking cessation programs should rely more heavily upon an understanding of, and direct confrontation with, the addiction itself, and less of an emphasis on merely replacing the nicotine in order to prevent withdrawal symptoms. As Dr. Lovelace points out: "Once physically dependent, total abstinence and permanently is what works. Tapering off doesn't. Even one '‘hit'’ of nicotine -– no matter the delivery method - makes someone not yet in the recovery that'’s required for him or her to survive. Public officials declare and confirm that nicotine is addictive. Then they give the opposite message: it isn'’t."
I tend to agree. In many ways, I believe that the preoccupation with nicotine replacement therapy, spurred on by the infusion of pharmaceutical dollars into the tobacco control field, is causing us to lose sight of the actual root of the problem: the addictive state itself. And that is a shame, because it may be severely hampering our efforts to help smokers quit.
Tuesday, February 21, 2006
Monday, February 20, 2006
CHALLENGING DOGMA: Post #9 - The Agenda of All Anti-Smoking Groups is a Noble One
One of the things that I always assumed during my early years in the tobacco control movement was that the agenda of anti-smoking organizations is always a noble one, and that any differences that I might ever have with these groups were about strategy, but not about the ultimate goal, which was a common one shared by all tobacco control groups.
The tobacco control community, I had been led to believe, consisted of organizations which all shared a common agenda, which was focused solely on the desire to reduce tobacco-related morbidity and mortality. Sure, from time to time, I would have disagreements about the way some groups were going about trying to achieve this goal, but these were just strategic or tactical issues. We needed to put these differences aside and work together since our purposes were, after all, the same.
This is a point that has been emphasized to me, over and over again, especially during the past months when I have been willing to write about my disagreements with the actions of a number of tobacco control groups. Usually, it has taken the form of advocates questioning my criticism of anti-smoking groups, not because of any fallacy in my argumentation, but because it is "wrong" and "counter-productive" to criticize since we are all working "for the same goals."
The Rest of the Story
It has become clear to me over the past few weeks that, in fact, we are not all working for the same goals, and that the agenda of all anti-smoking groups is not necessarily a noble one.
Most apparent is that a number of anti-smoking groups seem to be driven by a desire to punish smokers, to make their lives as miserable as possible, and to teach them a lesson for the damage they have caused to nonsmokers.
And they are doing this in the name of protecting health. But the justification behind their positions is so flimsy that it makes it clear, to me at least, that health is just part of the concerns that are motivating these actions.
Take Action on Smoking and Health (ASH), for example. In testimony before the Calabasas City Council, ASH supported the city's ban on smoking almost anywhere in the city, calling it a "comprehensive" law that would make Calabasas "the first truly smokefree city."
It based its support for this draconian law based not on any sound scientific data, but largely upon its conviction that secondhand smoke exposure is so "annoying and irritating to most people" and that "it is inappropriate to expose young children to that behavior [smoking] as a norm."
Interestingly, despite ASH's conviction that "no person should be involuntarily and unnecessarily exposed to any level, however low, of known cancer-causing substances," ASH apparently doesn't have any problem with exposing loads of children to these cancer-causing substances in a crowded open-air shopping mall, which the Calabasas law allows.
And apparently, you can become a truly smokefree city even if you allow kids to have to breathe in tobacco smoke while shopping at Gymboree, Johnny Rockets, Barnes & Noble, and M. Fredric kids (all are stores in the exempt Calabasas Commons shopping mall).
I think you have to question the sincerity of ASH's testimony just a little bit, given this complete contradiction, which basically invalidates its entire argument. If no person should be involuntarily exposed to any level of carcinogens, then how can ASH justify testifying in support of a law that allows for smoking at a crowded shopping mall?
And if it is that important for kids not to see smokers in public, how could ASH explain its support for a law that will most certainly result in great increases in smoking at one of the most crowded places where youths congregate in the city?
Really - it is clear to me that something else is going on here, other than an incredibly sincere concern for the possiblity that the children of Calabasas might be exposed to small amounts of secondhand smoke.
What I think is going on (and this is just my opinion) is that ASH really wants to rub smokers' faces in the dirt. I think they want to punish smokers by making their lives as miserable as possible. I think they are boasting about the draconian restrictions on smoking in Calabasas because it is a kind of payback for what they view as the damage that smokers have done to nonsmokers.
There's just no other possible way I could explain how ASH could support such an ordinance based on the arguments that ASH provides. And the fact that ASH is going so far out of its way to promote this ordinance and to boast about its support for it, and about the law's passage. And how ASH is going so far out of its way, despite its numerable press releases about this issue, not to mention the fact that the ordinance allows smoking at every shopping mall in the city.
Add to that the arguments that ASH is using. Apparently, they feel that seeing smokers in public is a moral affront, as they directly compare public smoking to public spitting, gambling, playing boom boxes, and leaving a dog’s droppings behind. I really think they view smokers as a complete public nuisance. And they appear to simply not want people to have to see smokers. They are defining the problem in such a way that it is not the smoke, but the smoker, that is offensive.
Take, for another example, the efforts of ASH as well as a number of other anti-smoking groups to promote policies that would eliminate smokers from the workforce. Can there really be a serious public health justification behind such policies? Or are these policies really just a way to punish smokers for what is viewed as their crimes against nonsmokers by exposing them to their smoke?
I have already mentioned the argument, being advanced by some anti-smoking groups, that smokers are not deserving of employment because residue they carry on their clothes or hair, or their exhaled breath (even if they haven't smoked for hours) is a severe health hazard. That argument itself pretty much seems to indicate, I think, that this has left the realm of public health and evidence-based public policy, and become an all-out effort to punish smokers and make them pay for their "sins" of exposing nonsmokers to their smoke.
I don't question the fact that such extremely sensitive individuals exist, but there are appropriate and effective ways of dealing with problems like this short of removing all smokers from the workplace.
And so I have come to realize that the agenda of all anti-smoking group is not necessarily a noble one. And I have come to this realization:
I do not agree with the agenda of some anti-smoking groups: namely, those which are promoting non-science-based bans on smoking in non-enclosed outdoors places where exposure to secondhand smoke is transient and avoidable and those which are promoting employment discrimination against smokers.
I do not agree with the goal of punishing smokers and making them pay for damages that may have been suffered by nonsmokers.
I reject the idea that smokers are a moral affront, a nuisance, something which we cannot allow our children to see.
I feel compelled, then, to let it be known that I reject certain aspects of the agenda that are being promoted by a number of anti-smoking groups, and I do not stand together with these groups in working towards a common goal. Not if that goal is to punish smokers, and the means to achieve that goal is to toss all science and evidence-based policy analysis aside. I just refuse to do that.
The rest of the story is that I do not believe that the agenda of all anti-smoking groups is a noble one. This is not just a strategic difference in opinion regarding the best way to get to where we are all trying to go. I am not trying to go where some of these groups are. I am going to pursue a different path, and I'm going to do my best to persuade my collagues to take that different road.
Yes, this goes against the dogma of the movement, and the dogma with which I was indoctrinated. But at some point, you have to be willing to stand for what you think is right. And I reject the notion that it is improper for me to criticize groups, since we're all working towards the same ends.
With respect to a number of these groups, we're not working towards the same ends, and I'll continue to speak out against the agenda that these groups are pursuing because I simply don't think it is an appropriate one.
I may not be successful in convincing my colleagues to reject these aspects of the anti-smoking agenda, but it won't be for lack of trying, and I won't walk off the field with there being any doubt that I publicly rejected these disturbing aspects of the anti-smoking agenda. At very least, I'll be able to say that I left it all on the field.
The tobacco control community, I had been led to believe, consisted of organizations which all shared a common agenda, which was focused solely on the desire to reduce tobacco-related morbidity and mortality. Sure, from time to time, I would have disagreements about the way some groups were going about trying to achieve this goal, but these were just strategic or tactical issues. We needed to put these differences aside and work together since our purposes were, after all, the same.
This is a point that has been emphasized to me, over and over again, especially during the past months when I have been willing to write about my disagreements with the actions of a number of tobacco control groups. Usually, it has taken the form of advocates questioning my criticism of anti-smoking groups, not because of any fallacy in my argumentation, but because it is "wrong" and "counter-productive" to criticize since we are all working "for the same goals."
The Rest of the Story
It has become clear to me over the past few weeks that, in fact, we are not all working for the same goals, and that the agenda of all anti-smoking groups is not necessarily a noble one.
Most apparent is that a number of anti-smoking groups seem to be driven by a desire to punish smokers, to make their lives as miserable as possible, and to teach them a lesson for the damage they have caused to nonsmokers.
And they are doing this in the name of protecting health. But the justification behind their positions is so flimsy that it makes it clear, to me at least, that health is just part of the concerns that are motivating these actions.
Take Action on Smoking and Health (ASH), for example. In testimony before the Calabasas City Council, ASH supported the city's ban on smoking almost anywhere in the city, calling it a "comprehensive" law that would make Calabasas "the first truly smokefree city."
It based its support for this draconian law based not on any sound scientific data, but largely upon its conviction that secondhand smoke exposure is so "annoying and irritating to most people" and that "it is inappropriate to expose young children to that behavior [smoking] as a norm."
Interestingly, despite ASH's conviction that "no person should be involuntarily and unnecessarily exposed to any level, however low, of known cancer-causing substances," ASH apparently doesn't have any problem with exposing loads of children to these cancer-causing substances in a crowded open-air shopping mall, which the Calabasas law allows.
And apparently, you can become a truly smokefree city even if you allow kids to have to breathe in tobacco smoke while shopping at Gymboree, Johnny Rockets, Barnes & Noble, and M. Fredric kids (all are stores in the exempt Calabasas Commons shopping mall).
I think you have to question the sincerity of ASH's testimony just a little bit, given this complete contradiction, which basically invalidates its entire argument. If no person should be involuntarily exposed to any level of carcinogens, then how can ASH justify testifying in support of a law that allows for smoking at a crowded shopping mall?
And if it is that important for kids not to see smokers in public, how could ASH explain its support for a law that will most certainly result in great increases in smoking at one of the most crowded places where youths congregate in the city?
Really - it is clear to me that something else is going on here, other than an incredibly sincere concern for the possiblity that the children of Calabasas might be exposed to small amounts of secondhand smoke.
What I think is going on (and this is just my opinion) is that ASH really wants to rub smokers' faces in the dirt. I think they want to punish smokers by making their lives as miserable as possible. I think they are boasting about the draconian restrictions on smoking in Calabasas because it is a kind of payback for what they view as the damage that smokers have done to nonsmokers.
There's just no other possible way I could explain how ASH could support such an ordinance based on the arguments that ASH provides. And the fact that ASH is going so far out of its way to promote this ordinance and to boast about its support for it, and about the law's passage. And how ASH is going so far out of its way, despite its numerable press releases about this issue, not to mention the fact that the ordinance allows smoking at every shopping mall in the city.
Add to that the arguments that ASH is using. Apparently, they feel that seeing smokers in public is a moral affront, as they directly compare public smoking to public spitting, gambling, playing boom boxes, and leaving a dog’s droppings behind. I really think they view smokers as a complete public nuisance. And they appear to simply not want people to have to see smokers. They are defining the problem in such a way that it is not the smoke, but the smoker, that is offensive.
Take, for another example, the efforts of ASH as well as a number of other anti-smoking groups to promote policies that would eliminate smokers from the workforce. Can there really be a serious public health justification behind such policies? Or are these policies really just a way to punish smokers for what is viewed as their crimes against nonsmokers by exposing them to their smoke?
I have already mentioned the argument, being advanced by some anti-smoking groups, that smokers are not deserving of employment because residue they carry on their clothes or hair, or their exhaled breath (even if they haven't smoked for hours) is a severe health hazard. That argument itself pretty much seems to indicate, I think, that this has left the realm of public health and evidence-based public policy, and become an all-out effort to punish smokers and make them pay for their "sins" of exposing nonsmokers to their smoke.
I don't question the fact that such extremely sensitive individuals exist, but there are appropriate and effective ways of dealing with problems like this short of removing all smokers from the workplace.
And so I have come to realize that the agenda of all anti-smoking group is not necessarily a noble one. And I have come to this realization:
I do not agree with the agenda of some anti-smoking groups: namely, those which are promoting non-science-based bans on smoking in non-enclosed outdoors places where exposure to secondhand smoke is transient and avoidable and those which are promoting employment discrimination against smokers.
I do not agree with the goal of punishing smokers and making them pay for damages that may have been suffered by nonsmokers.
I reject the idea that smokers are a moral affront, a nuisance, something which we cannot allow our children to see.
I feel compelled, then, to let it be known that I reject certain aspects of the agenda that are being promoted by a number of anti-smoking groups, and I do not stand together with these groups in working towards a common goal. Not if that goal is to punish smokers, and the means to achieve that goal is to toss all science and evidence-based policy analysis aside. I just refuse to do that.
The rest of the story is that I do not believe that the agenda of all anti-smoking groups is a noble one. This is not just a strategic difference in opinion regarding the best way to get to where we are all trying to go. I am not trying to go where some of these groups are. I am going to pursue a different path, and I'm going to do my best to persuade my collagues to take that different road.
Yes, this goes against the dogma of the movement, and the dogma with which I was indoctrinated. But at some point, you have to be willing to stand for what you think is right. And I reject the notion that it is improper for me to criticize groups, since we're all working towards the same ends.
With respect to a number of these groups, we're not working towards the same ends, and I'll continue to speak out against the agenda that these groups are pursuing because I simply don't think it is an appropriate one.
I may not be successful in convincing my colleagues to reject these aspects of the anti-smoking agenda, but it won't be for lack of trying, and I won't walk off the field with there being any doubt that I publicly rejected these disturbing aspects of the anti-smoking agenda. At very least, I'll be able to say that I left it all on the field.
Friday, February 17, 2006
Smokers Deemed Ineligible to Pursue Jobs in Health Care Field at Truman Medical Centers
According to a local FOX-News affiliate in Kansas City, smokers are no longer eligible for employment at the city's Truman Medical Centers.
According to the article: "If you smoke, you won't get a job at Truman Medical Centers. The hospital system will not hire any more tobacco users. The CEO says since they're in the health care business, they want to make a strong statement and set the example that smoking is a preventable health hazard."
The Rest of the Story
This is very solid and logical reasoning, don't you think?. I just have one suggestion for the Truman Medical Centers. If they are really interested in making a strong statement and setting the example about what preventable health hazards are, then they should also stop hiring obese people. Since they're in the health care business, don't they feel they should set an example regarding one of the nation's most important preventable health hazards - obesity?
And why stop there? Lack of physical activity is also an important preventable health hazard. So is a crappy diet. And so is unsafe sexual activity. Aren't these all unhealthy behaviors that Truman Medical Centers should make a strong statement about and for which they should set the example that these, in addition to smoking, are important preventable health hazards?
If you initiate an application to the Truman Medical Centers, you will be asked whether or not you use tobacco products. Apparently, if you say "yes," the application process is terminated.
This is a real shame. For one, there are a large number of smokers who are extremely highly qualified for jobs in the health care field. During my experience as a medical student, intern, resident, and part-time physician, I have worked with hundreds of other health care practitioners. And some of the very best practitioners I have been fortunate enough, and privileged enough to work with have been smokers.
And the patients who were cared for by these practitioners, who happened to smoke or use smokeless tobacco products, were also extremely fortunate and privileged.
And it seems a shame to disqualify this large segment of health care practitioners from the field solely because of a behavior they engage in within the privacy of their homes (this policy has nothing to do with smoking on-the-job, which is obviously banned at most medical centers). And that behavior is certainly not a bona fide job requirement due to its direct impact on job performance, at least for most medical center positions.
I wouldn't argue that perhaps a smoker might not be the best choice as a smoking cessation counselor, but for most other general health care positions, smokers can be, and many are, highly qualified. Many are more qualified than any nonsmoking applicants.
So let's get this straight. If I am a smoker, I cannot apply for the following position as a Coding Quality Specialist at Truman Medical Centers:
"In this position you will be responsible for conducting coding audits in any service; preparing coding quality reports for the Corporate HIM Coding Management team; maintaining accurate, detailed and consistent documentation of coding audit activity reporting and action; as well as staying abreast of current developments in coding classification."
Now how does the fact that I chew some Skoal every now and then or smoke off-the-job affect my ability to conduct coding audits, prepare quality reports, maintain documentation, and stay abreast of current developments? I just don't get it.
Or how about this one - a position as a Health Information Management Supervisor:
"Supervises staff and manages workflow in the Medical Record chart completion process. Monitors and evaluates the effectiveness of services in chart completion."
Does smoking off-the-job affect your ability to supervise staff and manage workflow and to monitor and evaluate the effectiveness of services? Hardly.
While the official job requirements for this position read:
"High School Diploma or GED required; associate or bachelor degree in health related field. Developed knowledge of Medical terminology. Previous management/supervisory experience required; experience with computer systems and applications. Registered Health Information Technologist (RHIT) or Registered Health Information Administrator (RHIA) or equivalent preferred. Excellent communication, verbal, written and listening skills; experience in medical record function preferred; available to participate in departmental on-call reachable by beeper 24 hours/day,"
they actually read:
"High School Diploma or GED required; associate or bachelor degree in health related field. Developed knowledge of Medical terminology. Previous management/supervisory experience required; experience with computer systems and applications. Registered Health Information Technologist (RHIT) or Registered Health Information Administrator (RHIA) or equivalent preferred. Excellent communication, verbal, written and listening skills; experience in medical record function preferred; available to participate in departmental on-call reachable by beeper 24 hours/day. Must not smoke or use smokeless tobacco in the privacy of your own home."
And if Truman Medical Centers were sincere about wanting to set a good example for preventable health hazards, then the job requirements should read:
"High School Diploma or GED required; associate or bachelor degree in health related field. Developed knowledge of Medical terminology. Previous management/supervisory experience required; experience with computer systems and applications. Registered Health Information Technologist (RHIT) or Registered Health Information Administrator (RHIA) or equivalent preferred. Excellent communication, verbal, written and listening skills; experience in medical record function preferred; available to participate in departmental on-call reachable by beeper 24 hours/day. Must not smoke or use smokeless tobacco in the privacy of your own home. Must have a body mass index of no more than 30.0. Must eat no more than 65 grams of fat per day. Must exercise for at least 30 minutes no less than twice per week. Must not engage in unsafe sexual activity. No tater tot eaters please. Other than this, we are an Equal Opportunity Employer."
What Truman Medical Centers is really saying is that smokers are undeserving of a career in the health field, simply because of a behavior that most started doing and became addicted to when they were 15, 16, or 17-years old.
I find that attitude to be most unbecoming of a Medical Center, which I had thought was supposed to have compassion and understanding for smokers, who make up a large proportion of its patients.
I see no reason why smokers should not be eligible for jobs in the health care field, or any other field, for that matter (maybe with the exception of smoking cessation counseling or working for an anti-smoking organization).
The rest of the story is that, plain and simple, bigotry is taking the disguise of people or businesses concerned about public health. And that's scary, because I shudder to think about what else these folks might be "concerned" about?
According to the article: "If you smoke, you won't get a job at Truman Medical Centers. The hospital system will not hire any more tobacco users. The CEO says since they're in the health care business, they want to make a strong statement and set the example that smoking is a preventable health hazard."
The Rest of the Story
This is very solid and logical reasoning, don't you think?. I just have one suggestion for the Truman Medical Centers. If they are really interested in making a strong statement and setting the example about what preventable health hazards are, then they should also stop hiring obese people. Since they're in the health care business, don't they feel they should set an example regarding one of the nation's most important preventable health hazards - obesity?
And why stop there? Lack of physical activity is also an important preventable health hazard. So is a crappy diet. And so is unsafe sexual activity. Aren't these all unhealthy behaviors that Truman Medical Centers should make a strong statement about and for which they should set the example that these, in addition to smoking, are important preventable health hazards?
If you initiate an application to the Truman Medical Centers, you will be asked whether or not you use tobacco products. Apparently, if you say "yes," the application process is terminated.
This is a real shame. For one, there are a large number of smokers who are extremely highly qualified for jobs in the health care field. During my experience as a medical student, intern, resident, and part-time physician, I have worked with hundreds of other health care practitioners. And some of the very best practitioners I have been fortunate enough, and privileged enough to work with have been smokers.
And the patients who were cared for by these practitioners, who happened to smoke or use smokeless tobacco products, were also extremely fortunate and privileged.
And it seems a shame to disqualify this large segment of health care practitioners from the field solely because of a behavior they engage in within the privacy of their homes (this policy has nothing to do with smoking on-the-job, which is obviously banned at most medical centers). And that behavior is certainly not a bona fide job requirement due to its direct impact on job performance, at least for most medical center positions.
I wouldn't argue that perhaps a smoker might not be the best choice as a smoking cessation counselor, but for most other general health care positions, smokers can be, and many are, highly qualified. Many are more qualified than any nonsmoking applicants.
So let's get this straight. If I am a smoker, I cannot apply for the following position as a Coding Quality Specialist at Truman Medical Centers:
"In this position you will be responsible for conducting coding audits in any service; preparing coding quality reports for the Corporate HIM Coding Management team; maintaining accurate, detailed and consistent documentation of coding audit activity reporting and action; as well as staying abreast of current developments in coding classification."
Now how does the fact that I chew some Skoal every now and then or smoke off-the-job affect my ability to conduct coding audits, prepare quality reports, maintain documentation, and stay abreast of current developments? I just don't get it.
Or how about this one - a position as a Health Information Management Supervisor:
"Supervises staff and manages workflow in the Medical Record chart completion process. Monitors and evaluates the effectiveness of services in chart completion."
Does smoking off-the-job affect your ability to supervise staff and manage workflow and to monitor and evaluate the effectiveness of services? Hardly.
While the official job requirements for this position read:
"High School Diploma or GED required; associate or bachelor degree in health related field. Developed knowledge of Medical terminology. Previous management/supervisory experience required; experience with computer systems and applications. Registered Health Information Technologist (RHIT) or Registered Health Information Administrator (RHIA) or equivalent preferred. Excellent communication, verbal, written and listening skills; experience in medical record function preferred; available to participate in departmental on-call reachable by beeper 24 hours/day,"
they actually read:
"High School Diploma or GED required; associate or bachelor degree in health related field. Developed knowledge of Medical terminology. Previous management/supervisory experience required; experience with computer systems and applications. Registered Health Information Technologist (RHIT) or Registered Health Information Administrator (RHIA) or equivalent preferred. Excellent communication, verbal, written and listening skills; experience in medical record function preferred; available to participate in departmental on-call reachable by beeper 24 hours/day. Must not smoke or use smokeless tobacco in the privacy of your own home."
And if Truman Medical Centers were sincere about wanting to set a good example for preventable health hazards, then the job requirements should read:
"High School Diploma or GED required; associate or bachelor degree in health related field. Developed knowledge of Medical terminology. Previous management/supervisory experience required; experience with computer systems and applications. Registered Health Information Technologist (RHIT) or Registered Health Information Administrator (RHIA) or equivalent preferred. Excellent communication, verbal, written and listening skills; experience in medical record function preferred; available to participate in departmental on-call reachable by beeper 24 hours/day. Must not smoke or use smokeless tobacco in the privacy of your own home. Must have a body mass index of no more than 30.0. Must eat no more than 65 grams of fat per day. Must exercise for at least 30 minutes no less than twice per week. Must not engage in unsafe sexual activity. No tater tot eaters please. Other than this, we are an Equal Opportunity Employer."
What Truman Medical Centers is really saying is that smokers are undeserving of a career in the health field, simply because of a behavior that most started doing and became addicted to when they were 15, 16, or 17-years old.
I find that attitude to be most unbecoming of a Medical Center, which I had thought was supposed to have compassion and understanding for smokers, who make up a large proportion of its patients.
I see no reason why smokers should not be eligible for jobs in the health care field, or any other field, for that matter (maybe with the exception of smoking cessation counseling or working for an anti-smoking organization).
The rest of the story is that, plain and simple, bigotry is taking the disguise of people or businesses concerned about public health. And that's scary, because I shudder to think about what else these folks might be "concerned" about?
Calabasas Adopts Broad Outdoor Smoking Ban; Encourages Nonsmokers to Report People Seen Smoking on Streets and Sidewalks
The Calabasas (California) City Council gave final approval Wednesday to an ordinance that would ban smoking virtually everywhere outside in the city, including streets, sidewalks, and parking lots. Smoking is banned in all of these areas any time there is someone within 20 feet who is not themselves smoking or who has not specifically consented to the individual smoking.
However, the broad smoking ban, designed not only to protect people from secondhand smoke exposure but to reduce "the potential for children to associate smoking and tobacco with a healthy lifestyle" and to affirm and promote "the family-friendly atmosphere of the City'’s public places," allows smoking in designated outdoors areas at all the city's shopping malls, including the "open-air" Calabasas Commons shopping mall.
The City is encouraging nonsmokers to confront smokers who they see smoking on the street or to report them to the City for prosecution.
In response to the question "What should I do if I witness someone violating the ordinance?" the City states: "If you are walking down the street or in other public place, you can ask the smoker to extinguish their cigarette, cigar or pipe. If you are uncomfortable doing so or the person refuses your request, please feel free to contact City code enforcement at (818) 878-4225."
Starting on March 17, smoking on the street in Calabasas is a criminal offense - a misdemeanor - and can be prosecuted through lawsuits brought against individual smokers.
And, in a little-noticed provision in the bill, any nonsmokers in the city can file a lawsuit against any smoker they see smoking on the sidewalk or street near them (within 20 feet), in any situation where the City decides to prosecute the criminal offense with a fine rather than a lawsuit:
"Any person acting for the interests of him-, her-, or itself, or of its members, or of the general public (hereinafter 'a Private Enforcer') may bring a civil action to enforce this chapter... ."
The Rest of the Story
There are several aspects of this story that I think deserve comment:
1. The Hypocrisy
Who does the Calabasas City Council think it is kidding? Are we really expected to believe that they are so concerned about small amounts of exposure to secondhand smoke affecting nonsmokers that they need to ban smoking in every outdoor place, including every street, sidewalk and parking lot when people are present, when they have failed to provide protection in the one outdoor spot where the entire city of Calabasas congregates - the Calabasas Commons shopping mall?
It seems clear that secondhand smoke is a vital concern to the Calabasas City Council, but not quite as important as the revenue that comes in to the city from shoppers.
On an isolated street somewhere, secondhand smoke is apparently a devastating health hazard and smoking needs to be banned, but in the crowded, open-air shopping mall, no way the Council wants to touch it. God forbid they should lose some retail business due to a concern over people's health!
This hypocrisy is sickening and it leads me to question the integrity and sincerity of this effort as a public health measure. Something else, other than a sincere, evidence-based concern for the public's health, appears to be driving this, and I can safely suggest that it is not compassion for the residents in the city who are addicted to nicotine.
2. The Faulty and Dangerous Justification
This is not an evidence-based public health policy. I'm aware of no evidence that transient exposure to secondhand smoke, in the form of exposure to a smoker on a street, sidewalk or parking lot, is a significant health hazard. And it certainly is not a serious public health problem.
In contrast, I think one could make the argument that in a crowded open-air shopping mall packed with children, smoking could be a concern.
So I think it's quite clear that this policy is not justified based on any sound scientific or public health grounds.
More troubling, however, is the fact that the City Council is justifying this measure, in part, based on its desire to protect children from seeing smokers. What's next? Banning fat people from the public square so that children don't associate obesity with public acceptance? How about banning gay couples from public so that children don't associate homosexuality with being an acceptable lifestyle?
Moreover, the City has now declared, essentially, that smokers are not part of a family-friendly atmosphere. We can't let children see smokers in public because they apparently make the city family unfriendly. Are fat people family unfriendly too? And we already know a number of cities that consider homosexuality to be family unfriendly. Yet the precise reasoning being used in Calabasas would now justify actions to ban gay couples from public view.
3. The Draconian Nature of the Law
Even if one were to accept that transient exposure to secondhand smoke while walking down the street was a severe public health problem that required government intervention, it would still seem ridiculous to charge violators with a criminal offense.
And to allow, and in fact encourage lawsuits to be brought against smokers who light up in a parking lot is absolutely insane. What a tremendous waste of our judicial system. Don't city prosecutors, judges, and city courts have more important and pressing matters than conducting hearings and trials to determine whether someone was 19 or 21 feet away from a nonsmoker when they lit up a cigarette on a street corner?
4. The Encouragement of Confrontation and Tormenting of Smokers
It is quite clear that the city of Calabasas is encouraging and promoting confrontation between smokers and nonsmokers. They are creating a situation in which nonsmokers are encouraged to confront anyone they see smoking. And any individual in the city can now file a lawsuit against any other individual, simply for lighting up in public. Is this really the kind of "family friendly" atmosphere that the city of Calabasas wants to promote?
Honestly, it appears that this is exactly what Calabasas has in mind. Why else would they make this a criminal offense, allow lawsuits against individual smokers for lighting up in public, and specifically allow any individual to bring a lawsuit against any smoker who lights up?
I want to emphasize that there is nothing the city can do, under the law, to prevent a citizen from bringing a lawsuit against a smoker. If the city decides not to bring a lawsuit itself, then any citizen can bring a lawsuit against that smoker himself. And the city can't stop it.
The rest of the story is that anti-smoking efforts in Calabasas have long since left the realm of public health, scientific evidence-based policy, and simple reason. They have now entered the realm of complete insanity.
However, the broad smoking ban, designed not only to protect people from secondhand smoke exposure but to reduce "the potential for children to associate smoking and tobacco with a healthy lifestyle" and to affirm and promote "the family-friendly atmosphere of the City'’s public places," allows smoking in designated outdoors areas at all the city's shopping malls, including the "open-air" Calabasas Commons shopping mall.
The City is encouraging nonsmokers to confront smokers who they see smoking on the street or to report them to the City for prosecution.
In response to the question "What should I do if I witness someone violating the ordinance?" the City states: "If you are walking down the street or in other public place, you can ask the smoker to extinguish their cigarette, cigar or pipe. If you are uncomfortable doing so or the person refuses your request, please feel free to contact City code enforcement at (818) 878-4225."
Starting on March 17, smoking on the street in Calabasas is a criminal offense - a misdemeanor - and can be prosecuted through lawsuits brought against individual smokers.
And, in a little-noticed provision in the bill, any nonsmokers in the city can file a lawsuit against any smoker they see smoking on the sidewalk or street near them (within 20 feet), in any situation where the City decides to prosecute the criminal offense with a fine rather than a lawsuit:
"Any person acting for the interests of him-, her-, or itself, or of its members, or of the general public (hereinafter 'a Private Enforcer') may bring a civil action to enforce this chapter... ."
The Rest of the Story
There are several aspects of this story that I think deserve comment:
1. The Hypocrisy
Who does the Calabasas City Council think it is kidding? Are we really expected to believe that they are so concerned about small amounts of exposure to secondhand smoke affecting nonsmokers that they need to ban smoking in every outdoor place, including every street, sidewalk and parking lot when people are present, when they have failed to provide protection in the one outdoor spot where the entire city of Calabasas congregates - the Calabasas Commons shopping mall?
It seems clear that secondhand smoke is a vital concern to the Calabasas City Council, but not quite as important as the revenue that comes in to the city from shoppers.
On an isolated street somewhere, secondhand smoke is apparently a devastating health hazard and smoking needs to be banned, but in the crowded, open-air shopping mall, no way the Council wants to touch it. God forbid they should lose some retail business due to a concern over people's health!
This hypocrisy is sickening and it leads me to question the integrity and sincerity of this effort as a public health measure. Something else, other than a sincere, evidence-based concern for the public's health, appears to be driving this, and I can safely suggest that it is not compassion for the residents in the city who are addicted to nicotine.
2. The Faulty and Dangerous Justification
This is not an evidence-based public health policy. I'm aware of no evidence that transient exposure to secondhand smoke, in the form of exposure to a smoker on a street, sidewalk or parking lot, is a significant health hazard. And it certainly is not a serious public health problem.
In contrast, I think one could make the argument that in a crowded open-air shopping mall packed with children, smoking could be a concern.
So I think it's quite clear that this policy is not justified based on any sound scientific or public health grounds.
More troubling, however, is the fact that the City Council is justifying this measure, in part, based on its desire to protect children from seeing smokers. What's next? Banning fat people from the public square so that children don't associate obesity with public acceptance? How about banning gay couples from public so that children don't associate homosexuality with being an acceptable lifestyle?
Moreover, the City has now declared, essentially, that smokers are not part of a family-friendly atmosphere. We can't let children see smokers in public because they apparently make the city family unfriendly. Are fat people family unfriendly too? And we already know a number of cities that consider homosexuality to be family unfriendly. Yet the precise reasoning being used in Calabasas would now justify actions to ban gay couples from public view.
3. The Draconian Nature of the Law
Even if one were to accept that transient exposure to secondhand smoke while walking down the street was a severe public health problem that required government intervention, it would still seem ridiculous to charge violators with a criminal offense.
And to allow, and in fact encourage lawsuits to be brought against smokers who light up in a parking lot is absolutely insane. What a tremendous waste of our judicial system. Don't city prosecutors, judges, and city courts have more important and pressing matters than conducting hearings and trials to determine whether someone was 19 or 21 feet away from a nonsmoker when they lit up a cigarette on a street corner?
4. The Encouragement of Confrontation and Tormenting of Smokers
It is quite clear that the city of Calabasas is encouraging and promoting confrontation between smokers and nonsmokers. They are creating a situation in which nonsmokers are encouraged to confront anyone they see smoking. And any individual in the city can now file a lawsuit against any other individual, simply for lighting up in public. Is this really the kind of "family friendly" atmosphere that the city of Calabasas wants to promote?
Honestly, it appears that this is exactly what Calabasas has in mind. Why else would they make this a criminal offense, allow lawsuits against individual smokers for lighting up in public, and specifically allow any individual to bring a lawsuit against any smoker who lights up?
I want to emphasize that there is nothing the city can do, under the law, to prevent a citizen from bringing a lawsuit against a smoker. If the city decides not to bring a lawsuit itself, then any citizen can bring a lawsuit against that smoker himself. And the city can't stop it.
The rest of the story is that anti-smoking efforts in Calabasas have long since left the realm of public health, scientific evidence-based policy, and simple reason. They have now entered the realm of complete insanity.
Thursday, February 16, 2006
American Legacy Foundation Partners Bringing Glamorous Tobacco Messages to America's Young People
According to the American Legacy Foundation, which reports to be trying to "build a world where young people reject tobacco and anyone can quit," the Foundation is concerned about tobacco industry methods "of attracting new smokers" because this "will undermine the significant achievements the public health community has made in reducing smoking rates among young people."
In particular, Legacy is concerned because "After cigarettes, cigars are the most commonly used tobacco product. Twelve percent of high school students and 6 percent of middle school students report current cigar use." Legacy is also concerned, apparently, because "cigar smokers and smokeless tobacco users face an increased risk of death compared with people who do not use any tobacco products."
Legacy also specifically bemoans the fact that "teens are still exposed to tobacco ads nearly as often as young adults are, and awareness levels among all groups are still considerable" and concludes that "Given the strong, accumulated evidence documenting the effect of cigarette advertising on youth smoking behavior, these data are cause for concern. ... Our results highlight the inadequacy of current advertising restrictions to protect youth from persuasive messages that may cause them to experiment with cigarette smoking. ... these findings warrant a heightened level of vigilance over the channels through which the tobacco industry targets teens and young adults."
The Rest of the Story
One of the major methods by which "the tobacco industry targets teens and young adults" is through advertising in magazines with high numbers of youth and young adult readers. And some of the most important magazines which carry those ads to youths and young adults are Sports Illustrated, Popular Mechanics, Esquire, and Cosmopolitan.
These magazines are published by Time Inc. and by the Hearst Corporation.
But that's not the rest of the story.
The rest of the story is that the American Legacy Foundation has established a series of corporate partnerships with companies that it claims are "standing as leaders in this important movement."
And two of these partnerships are with...
...Time Warner and the Hearst Corporation.
So let's look at what these "leaders" in the tobacco control movement that Legacy has courted are doing, just through the current issues of the above magazines, to
I have to tell you that I mentioned Legacy's corporate partnerships yesterday in my public health advocacy class and the students' jaws practically dropped off. They simply could not believe that a public health organization, much less a tobacco control organization dedicated to building a world where young people can reject tobacco, would forge a corporate partnership with the very companies that are responsible for delivering glamorous pro-smoking messages to millions of boys, girls, and young men and women throughout the nation.
I had to show the students Legacy's website to prove to them that this is a true story, not something I was making up to illustrate a point.
While I had intended on discussing this for a couple of minutes, simply to make a point about how one has to be careful in building a public health organization and even in building partnerships, because very often the partners that one obtains can severely limit or undermine the organization's ability to carry out its mission effectively, this turned into an hour-long discussion, with the students leaving the classroom boggled as to how and why a major tobacco control organization could and would do such a thing.
It really does undermine not only the work that Legacy needs to do, but the work of the rest of the tobacco control community.
For example, the American Legacy Foundation has forged a partnership with Girls, Inc., "a national nonprofit youth organization dedicated to inspiring all girls to be strong, smart, and bold."
How can Legacy on the one hand, partner with an organization that is teaching girls how to be bold and resist tobacco advertising and on the other hand, partner with an organization that is carrying messages to teach girls that smoking Kool cigarettes is the way to "Be Bold and Be True" that smoking Kools is the way to "Be Authentic and Be True" and that smoking Camels is jazzy, sexy, glamorous, and fashionable?
I think that for its own effectiveness, as well as to eliminate this awkward and ridiculous hypocrisy and to eliminate the tremendous undermining of efforts of the rest of the tobacco control community, Legacy has got to rescind its corporate partnerships with these companies.
Doing so would send a strong message that the American Legacy Foundation actually believes and will act on the "rhetoric" it is putting out, that the Foundation has some basic principles and will stand up for them, that money and funding is not the be-all and end-all and does not supercede integrity, and that in order to be included as a leader in the tobacco control movement, you simply cannot expose millions of youths to glamorous, sexy, appealing, and effective tobacco advertising, no matter how many ads for the Legacy Foundation you may agree to carry.
In fact, rescinding these partnerships would serve as a strong and effective intervention and message in itself. The media attention it would garner would do more to get the message out there about the exposure of youths and young people to tobacco advertising and the need to address these problems than anything else I can imagine Legacy doing.
I think it's "Time" for Legacy to stand up for something. It's certainly stood up for what it believes in the courtroom, fighting for the principle of being able to tell the truth about what cigarette companies are doing. And it stood up to Philip Morris initially, when the company was attempting to prevent it from airing hard-hitting ads.
Now it's time for Legacy to stand up to itself.
This is the right thing to do, and the time is now.
In particular, Legacy is concerned because "After cigarettes, cigars are the most commonly used tobacco product. Twelve percent of high school students and 6 percent of middle school students report current cigar use." Legacy is also concerned, apparently, because "cigar smokers and smokeless tobacco users face an increased risk of death compared with people who do not use any tobacco products."
Legacy also specifically bemoans the fact that "teens are still exposed to tobacco ads nearly as often as young adults are, and awareness levels among all groups are still considerable" and concludes that "Given the strong, accumulated evidence documenting the effect of cigarette advertising on youth smoking behavior, these data are cause for concern. ... Our results highlight the inadequacy of current advertising restrictions to protect youth from persuasive messages that may cause them to experiment with cigarette smoking. ... these findings warrant a heightened level of vigilance over the channels through which the tobacco industry targets teens and young adults."
The Rest of the Story
One of the major methods by which "the tobacco industry targets teens and young adults" is through advertising in magazines with high numbers of youth and young adult readers. And some of the most important magazines which carry those ads to youths and young adults are Sports Illustrated, Popular Mechanics, Esquire, and Cosmopolitan.
These magazines are published by Time Inc. and by the Hearst Corporation.
But that's not the rest of the story.
The rest of the story is that the American Legacy Foundation has established a series of corporate partnerships with companies that it claims are "standing as leaders in this important movement."
And two of these partnerships are with...
...Time Warner and the Hearst Corporation.
So let's look at what these "leaders" in the tobacco control movement that Legacy has courted are doing, just through the current issues of the above magazines, to
- help improve the health of our nation's youths and young adults;
- to build a world where young people can reject tobacco;
- to address the problem of cigar and smokeless tobacco use; and
- to address the problem of bombardment of young people with pro-tobacco messages in magazines:
- A full-page smokeless tobacco ad for Timber Wolf wintergreen and Skoal, offering a free can of Timber Wolf, opposite a rear-view picture of model Yamila Diaz-Rahi in a rather skimpy white Calvin Klein swimsuit (if you can call it that); and
- A full-page Kool (Be Bold. Be True) ad featuring a topless female with a large serpentine tattoo covering most of her back, opposite a nearly full-page "spread" of Sports Illustrated swimsuit issue perennial Elle Macpherson.
- Through Popular Mechanics, a full-page Skoal wintergreen ad ("Sometimes the perfect pinch is a pouch") and a full-page Copenhagen ad ("Copenhagen pouches. Made for the great indoors"). This ad shows a man at a bar, and suggests that smokeless tobacco is a great alternative for smokers who cannot smoke because of bar smoking bans;
- Through Esquire, a full-page cigar ad; and
- Through Cosmopolitan, a full-page Camel ad featuring an African-American trumpet player holding a Kool cigarette ("Be Authentic. Be True"), opposite actor Terrence Howard telling girls "Women want the same thing that men want -- to be happy and appreciated." I'd have to say that I agree with that. Charmingly, Howard "played a pimp wit a heart of gold in Hustle and Flow," and the bravest thing he says he's ever done is "getting naked on-set" in Get Rich or Die Tryin'. This ad actually precedes by a few pages the illuminating article on "60 Sexy Surprises."
I have to tell you that I mentioned Legacy's corporate partnerships yesterday in my public health advocacy class and the students' jaws practically dropped off. They simply could not believe that a public health organization, much less a tobacco control organization dedicated to building a world where young people can reject tobacco, would forge a corporate partnership with the very companies that are responsible for delivering glamorous pro-smoking messages to millions of boys, girls, and young men and women throughout the nation.
I had to show the students Legacy's website to prove to them that this is a true story, not something I was making up to illustrate a point.
While I had intended on discussing this for a couple of minutes, simply to make a point about how one has to be careful in building a public health organization and even in building partnerships, because very often the partners that one obtains can severely limit or undermine the organization's ability to carry out its mission effectively, this turned into an hour-long discussion, with the students leaving the classroom boggled as to how and why a major tobacco control organization could and would do such a thing.
It really does undermine not only the work that Legacy needs to do, but the work of the rest of the tobacco control community.
For example, the American Legacy Foundation has forged a partnership with Girls, Inc., "a national nonprofit youth organization dedicated to inspiring all girls to be strong, smart, and bold."
How can Legacy on the one hand, partner with an organization that is teaching girls how to be bold and resist tobacco advertising and on the other hand, partner with an organization that is carrying messages to teach girls that smoking Kool cigarettes is the way to "Be Bold and Be True" that smoking Kools is the way to "Be Authentic and Be True" and that smoking Camels is jazzy, sexy, glamorous, and fashionable?
I think that for its own effectiveness, as well as to eliminate this awkward and ridiculous hypocrisy and to eliminate the tremendous undermining of efforts of the rest of the tobacco control community, Legacy has got to rescind its corporate partnerships with these companies.
Doing so would send a strong message that the American Legacy Foundation actually believes and will act on the "rhetoric" it is putting out, that the Foundation has some basic principles and will stand up for them, that money and funding is not the be-all and end-all and does not supercede integrity, and that in order to be included as a leader in the tobacco control movement, you simply cannot expose millions of youths to glamorous, sexy, appealing, and effective tobacco advertising, no matter how many ads for the Legacy Foundation you may agree to carry.
In fact, rescinding these partnerships would serve as a strong and effective intervention and message in itself. The media attention it would garner would do more to get the message out there about the exposure of youths and young people to tobacco advertising and the need to address these problems than anything else I can imagine Legacy doing.
I think it's "Time" for Legacy to stand up for something. It's certainly stood up for what it believes in the courtroom, fighting for the principle of being able to tell the truth about what cigarette companies are doing. And it stood up to Philip Morris initially, when the company was attempting to prevent it from airing hard-hitting ads.
Now it's time for Legacy to stand up to itself.
This is the right thing to do, and the time is now.
Wednesday, February 15, 2006
Does the Existence of Individuals with Extreme Smoke-Sensitivity Justify Policies to Preclude Smokers from the Workplace?
One of the responses I have received to my posts arguing against policies that fire smokers or refuse to hire smokers solely on the basis of off-the-job smoking is that off-the-job smoking does in fact affect co-workers at the worksite because smoke residues on the smoker and/or exhaled smoke long after the smoker smoked the last cigarette could cause low levels of exposure to tobacco smoke, which could harm people who are highly sensitive to secondhand smoke.
For example, one commenter suggested that: "smokers stink like an ashtray because smoke remains on their hair and clothing (which can offend coworkers and customers), - smokers continue exhaling tobacco smoke pollutants for more than an hour after they've smoked their last cigarette (which creates tobacco smoke pollution in smokefree workplaces)."
Two other commenters have pointed out that they are extremely sensitive to tobacco smoke, and that an asthmatic reaction can be triggered by even small amounts of secondhand smoke exposure.
This argument has been used by some to justify policies that would preclude smokers from the workplace (by firing existing smokers and refusing to hire smokers as new employees).
In this post, I address the issue of individuals who are extremely sensitive to tobacco smoke and the argument that this justifies such policies.
The Rest of the Story
First of all, let me say that I do not doubt that there are a small number of individuals who are super-sensitive to secondhand smoke such that even very low exposure can trigger adverse health effects, such as an asthmatic reaction. So I am not going to contest the contention that in rare circumstances, exhaled smoke from a smoker who is not currently smoking may be detrimental to the health of a co-worker.
But two points are worth mentioning. First, it is certainly a small number of individuals, so far as we can tell. I have not seen any scientific literature documenting this as a commonly-seen problem in medicine. There is no evidence that this is more than a problem under rare circumstances.
Second, it is a problem that is not unique to tobacco smoke exposure. In fact, respiratory sensitivity to chemicals is much more common with other substances; in particular, allergens. There are a number of people with severe allergies or severe asthma, so severe that even small amounts of cat hair on a co-worker could trigger an allergic or asthmatic reaction. I have myself treated a fair number of individuals with multiple chemical sensitivity, a disorder in which the individual is super-sensitive to a wide range or possible environmental chemical exposures.
And many of us are familiar with children who are so allergic to peanuts that even transmitting a small amount of peanut butter from the hand of another child may cause an allergic reaction. There are also some individuals with respiratory disease who are very sensitive to the smell of perfumes and perfume exposure can trigger an adverse reaction in these individuals.
So it is entirely a fair question to ask how to appropriately handle these situations. And I think that the most appropriate method is to tackle them on a case-by-case basis. In other words, where we have an identified individual who is highly sensitive, appropriate accommodations need to be made to protect that person from the insulting exposure and to allow them to function as normally as possible.
In the workplace, we actually have a law that requires employers to accommodate employees who have extreme sensitivity to particular chemical exposures. As long as they are deemed medically disabled (which something like multiple chemical sensitivity or extreme sensitivity to tobacco smoke or cat hair or perfume would represent), they are entitled (under the Americans with Disabilities Act) to a reasonable accommodation from their employer.
But it is important to note that a reasonable accommodation would unlikely necessitate the firing of all smokers in the workplace, all people who wear perfume in the workplace, or all people who own cats in the workplace.
Similarly, most schools do not deal with the problem of peanut allergies by banning all students from eating peanut butter or refusing to allow students who consume peanut butter. Most schools deal with the problem either by: (1) banning students from bringing peanut-containing products to school; or (2) setting up peanut-free zones to accommodate the children who are allergic to peanuts.
It seems to me that presence of individuals who are extremely sensitive to tobacco smoke or to a number of other chemical and allergenic exposures does not justify a widespread policy of precluding from all workplaces all people who might present the risk of any exposure to the list of agents to which some individuals are sensitive.
There is no question that these individuals deserve and require accommodation. But the problem does not in any way justify policies to cleanse all workplaces of all smokers, all cat owners, all peanut butter eaters, and all perfume wearers.
While I completely understand and respect the opinions of those who are themselves extremely sensitive to tobacco smoke (while I still disagree with the argument that this problem in any way justifies precluding smokers from the workplace), I have to honestly question the motivation of others who are advancing this argument to promote workplace smoker bans.
It seems to me that this argument is so far off the mark that there may be something more fundamental driving the use of this as a justification for smoker bans. Perhaps it is anger at, and/or a desire to punish smokers. But whatever the reason, I just don't buy the argument.
The rest of the story is that the existence of individuals with extreme smoke-sensitivity does not in any way justify policies that ban smokers from workplaces.
If we, as tobacco control practitioners, want to advance policies that eliminate the smoke, fine. But eliminating the smokers from the job market is promoting no public health interest, and no interest at all, other than perhaps hate, intolerance, and bigotry.
For example, one commenter suggested that: "smokers stink like an ashtray because smoke remains on their hair and clothing (which can offend coworkers and customers), - smokers continue exhaling tobacco smoke pollutants for more than an hour after they've smoked their last cigarette (which creates tobacco smoke pollution in smokefree workplaces)."
Two other commenters have pointed out that they are extremely sensitive to tobacco smoke, and that an asthmatic reaction can be triggered by even small amounts of secondhand smoke exposure.
This argument has been used by some to justify policies that would preclude smokers from the workplace (by firing existing smokers and refusing to hire smokers as new employees).
In this post, I address the issue of individuals who are extremely sensitive to tobacco smoke and the argument that this justifies such policies.
The Rest of the Story
First of all, let me say that I do not doubt that there are a small number of individuals who are super-sensitive to secondhand smoke such that even very low exposure can trigger adverse health effects, such as an asthmatic reaction. So I am not going to contest the contention that in rare circumstances, exhaled smoke from a smoker who is not currently smoking may be detrimental to the health of a co-worker.
But two points are worth mentioning. First, it is certainly a small number of individuals, so far as we can tell. I have not seen any scientific literature documenting this as a commonly-seen problem in medicine. There is no evidence that this is more than a problem under rare circumstances.
Second, it is a problem that is not unique to tobacco smoke exposure. In fact, respiratory sensitivity to chemicals is much more common with other substances; in particular, allergens. There are a number of people with severe allergies or severe asthma, so severe that even small amounts of cat hair on a co-worker could trigger an allergic or asthmatic reaction. I have myself treated a fair number of individuals with multiple chemical sensitivity, a disorder in which the individual is super-sensitive to a wide range or possible environmental chemical exposures.
And many of us are familiar with children who are so allergic to peanuts that even transmitting a small amount of peanut butter from the hand of another child may cause an allergic reaction. There are also some individuals with respiratory disease who are very sensitive to the smell of perfumes and perfume exposure can trigger an adverse reaction in these individuals.
So it is entirely a fair question to ask how to appropriately handle these situations. And I think that the most appropriate method is to tackle them on a case-by-case basis. In other words, where we have an identified individual who is highly sensitive, appropriate accommodations need to be made to protect that person from the insulting exposure and to allow them to function as normally as possible.
In the workplace, we actually have a law that requires employers to accommodate employees who have extreme sensitivity to particular chemical exposures. As long as they are deemed medically disabled (which something like multiple chemical sensitivity or extreme sensitivity to tobacco smoke or cat hair or perfume would represent), they are entitled (under the Americans with Disabilities Act) to a reasonable accommodation from their employer.
But it is important to note that a reasonable accommodation would unlikely necessitate the firing of all smokers in the workplace, all people who wear perfume in the workplace, or all people who own cats in the workplace.
Similarly, most schools do not deal with the problem of peanut allergies by banning all students from eating peanut butter or refusing to allow students who consume peanut butter. Most schools deal with the problem either by: (1) banning students from bringing peanut-containing products to school; or (2) setting up peanut-free zones to accommodate the children who are allergic to peanuts.
It seems to me that presence of individuals who are extremely sensitive to tobacco smoke or to a number of other chemical and allergenic exposures does not justify a widespread policy of precluding from all workplaces all people who might present the risk of any exposure to the list of agents to which some individuals are sensitive.
There is no question that these individuals deserve and require accommodation. But the problem does not in any way justify policies to cleanse all workplaces of all smokers, all cat owners, all peanut butter eaters, and all perfume wearers.
While I completely understand and respect the opinions of those who are themselves extremely sensitive to tobacco smoke (while I still disagree with the argument that this problem in any way justifies precluding smokers from the workplace), I have to honestly question the motivation of others who are advancing this argument to promote workplace smoker bans.
It seems to me that this argument is so far off the mark that there may be something more fundamental driving the use of this as a justification for smoker bans. Perhaps it is anger at, and/or a desire to punish smokers. But whatever the reason, I just don't buy the argument.
The rest of the story is that the existence of individuals with extreme smoke-sensitivity does not in any way justify policies that ban smokers from workplaces.
If we, as tobacco control practitioners, want to advance policies that eliminate the smoke, fine. But eliminating the smokers from the job market is promoting no public health interest, and no interest at all, other than perhaps hate, intolerance, and bigotry.
Washington Lawmakers Considering Bill to Prevent Employment Discrimination Against Smokers
Under a bill being considered by the Washington legislature, it would become illegal for employers to refuse to hire smokers or to fire existing smokers based solely on their off-the-job smoking behavior.
This legislation comes in the wake of an increasing trend of employers adopting policies that discriminate against smokers by making off-the-job smoking a criterion for employment. It also follows the recent efforts of a prominent anti-smoking group - Action on Smoking and Health - to push for such policies both in the United States and internationally.
The concern over discrimination against smokers is of particular concern in Washington State, since a number of employers in the state have adopted policies making off-the-job smoking a criterion for rejection for employment. According to an article on a Seattle NBC affiliate website:
"Smoking isn't allowed at the Tacoma-Pierce County Health department. Light up off the job and you'll be fired. 'We basically have people sign an affidavit saying that they are smoke-free and coming on board and they will not smoke during their employment,' said Vivienne Kemphaus, Tacoma-Pierce County Health Department. ... For years, both Alaska Airlines and Avista Corporation have required applicants take a urine test that can detect a metabolite created when the body processes nicotine."
According to the proposed bill (House Bill 2614): "It is unlawful for an employer to refuse to hire or to discharge an individual, or otherwise disadvantage an individual, with respect to compensation, terms, conditions, or privileges of employment because the individual engages in the consumption of lawful tobacco products off the premises of the employer during nonworking hours, provided the individual complies with applicable laws or policies regulating consumption of lawful tobacco products on the premises of the employer during working hours."
The bill provides exceptions for two situations: (1) if off-the-job smoking interferes with a bona fide occupational job requirement; or (2) if off-the-job smoking is in conflict with the underlying mission of the employer.
The Rest of the Story
I have to admit that I have been, and remain, very reluctant to support or advocate for government intervention into employers' abilities to make their own employment decisions.
However, something has happened which has changed my mind.
Namely, it has become clear to me that there is a concerted effort within the anti-smoking movement to try to punish smokers by institutionalizing employment discrimination policies against them. As I have been highlighting for weeks, Action on Smoking and Health (ASH) is pushing for such policies throughout the United States and the world, and not a single other U.S. anti-smoking group has spoken out against such policies.
The spread of these policies threatens to make smokers second-class citizens who, solely because of a lawful private decision regarding what to do in their own homes, are unable to obtain gainful employment. It punishes children, who have no part in the decisions of their parents, by forcing their parents to become unemployed and less able to support them. It represents ugly workplace discrimination, as well as undue and dangerous intrusion into the privacy of employees.
And, as much as I hate to advocate for government intervention into employment decisions, I think that it is time for the government to step in and put an end to it.
I simply do not see anything within the tobacco control movement to suggest that there is any degree of compassion, reason, or good sense, or a willingness among those organizations which do have compassion, reason, or good sense to publicly speak out against this. And thus, I think smokers do need and deserve protection.
The legislation is carefully crafted so that it does not interfere with the ability of employers to make off-the-job smoking a condition of employment if it interferes with bona fide occupational job requirements or if it represents a conflict with the underlying mission of the organization.
Thus, the bill would not require anti-smoking organizations to hire smokers. Nor would it require employers at jobs which expose their employees to dangerous respiratory toxins to hire smokers. Thus, the legislation respects the two conditions that I think would make consideration of off-the-job smoking a valid employment criterion.
Moreover, the bill does not follow the approach of some states in making smoking equivalent to things such as sex, race, or religion in terms of preventing discrimination.
Based on what I have observed in the anti-smoking movement in the past months, both in terms of acts of commission (groups actively speaking out for employment discrimination against smokers) and acts of omission (the rest of the groups not speaking out against these policies), I think it is reasonably necessary for the government to intervene to protect the interests of smokers.
Actually, what I am advocating is not merely the protection of smokers. It is, more basically, the protection of all citizens against arbitrary employment discrimination and the protection of the basic privacy of employees to make their own decisions about what lawful behaviors to engage in within their own homes. These are basic values that transcend the issue of smoking, and I think are well worthy of government intervention.
I therefore support Washington's House Bill 2614, and hope that it will pass and set an example for other states that lack such protection for smokers (and all other lawful, off-the-job private behaviors) to follow.
This legislation comes in the wake of an increasing trend of employers adopting policies that discriminate against smokers by making off-the-job smoking a criterion for employment. It also follows the recent efforts of a prominent anti-smoking group - Action on Smoking and Health - to push for such policies both in the United States and internationally.
The concern over discrimination against smokers is of particular concern in Washington State, since a number of employers in the state have adopted policies making off-the-job smoking a criterion for rejection for employment. According to an article on a Seattle NBC affiliate website:
"Smoking isn't allowed at the Tacoma-Pierce County Health department. Light up off the job and you'll be fired. 'We basically have people sign an affidavit saying that they are smoke-free and coming on board and they will not smoke during their employment,' said Vivienne Kemphaus, Tacoma-Pierce County Health Department. ... For years, both Alaska Airlines and Avista Corporation have required applicants take a urine test that can detect a metabolite created when the body processes nicotine."
According to the proposed bill (House Bill 2614): "It is unlawful for an employer to refuse to hire or to discharge an individual, or otherwise disadvantage an individual, with respect to compensation, terms, conditions, or privileges of employment because the individual engages in the consumption of lawful tobacco products off the premises of the employer during nonworking hours, provided the individual complies with applicable laws or policies regulating consumption of lawful tobacco products on the premises of the employer during working hours."
The bill provides exceptions for two situations: (1) if off-the-job smoking interferes with a bona fide occupational job requirement; or (2) if off-the-job smoking is in conflict with the underlying mission of the employer.
The Rest of the Story
I have to admit that I have been, and remain, very reluctant to support or advocate for government intervention into employers' abilities to make their own employment decisions.
However, something has happened which has changed my mind.
Namely, it has become clear to me that there is a concerted effort within the anti-smoking movement to try to punish smokers by institutionalizing employment discrimination policies against them. As I have been highlighting for weeks, Action on Smoking and Health (ASH) is pushing for such policies throughout the United States and the world, and not a single other U.S. anti-smoking group has spoken out against such policies.
The spread of these policies threatens to make smokers second-class citizens who, solely because of a lawful private decision regarding what to do in their own homes, are unable to obtain gainful employment. It punishes children, who have no part in the decisions of their parents, by forcing their parents to become unemployed and less able to support them. It represents ugly workplace discrimination, as well as undue and dangerous intrusion into the privacy of employees.
And, as much as I hate to advocate for government intervention into employment decisions, I think that it is time for the government to step in and put an end to it.
I simply do not see anything within the tobacco control movement to suggest that there is any degree of compassion, reason, or good sense, or a willingness among those organizations which do have compassion, reason, or good sense to publicly speak out against this. And thus, I think smokers do need and deserve protection.
The legislation is carefully crafted so that it does not interfere with the ability of employers to make off-the-job smoking a condition of employment if it interferes with bona fide occupational job requirements or if it represents a conflict with the underlying mission of the organization.
Thus, the bill would not require anti-smoking organizations to hire smokers. Nor would it require employers at jobs which expose their employees to dangerous respiratory toxins to hire smokers. Thus, the legislation respects the two conditions that I think would make consideration of off-the-job smoking a valid employment criterion.
Moreover, the bill does not follow the approach of some states in making smoking equivalent to things such as sex, race, or religion in terms of preventing discrimination.
Based on what I have observed in the anti-smoking movement in the past months, both in terms of acts of commission (groups actively speaking out for employment discrimination against smokers) and acts of omission (the rest of the groups not speaking out against these policies), I think it is reasonably necessary for the government to intervene to protect the interests of smokers.
Actually, what I am advocating is not merely the protection of smokers. It is, more basically, the protection of all citizens against arbitrary employment discrimination and the protection of the basic privacy of employees to make their own decisions about what lawful behaviors to engage in within their own homes. These are basic values that transcend the issue of smoking, and I think are well worthy of government intervention.
I therefore support Washington's House Bill 2614, and hope that it will pass and set an example for other states that lack such protection for smokers (and all other lawful, off-the-job private behaviors) to follow.
Tuesday, February 14, 2006
IN MY VIEW: It's Time to Be Forthright About Smoke-Free Laws
Over the past few months, I have obtained the impression that anti-smoking groups feel that all smoke-free laws that they are supporting make perfect public health sense and will not cause harm to anyone, and that anyone who challenges this dogma is not only wrong but needs to be attacked.
But the truth is that a number of smoking policies that some anti-smoking groups have supported do not make a whole lot of public health sense and would, in fact, cause harm to a substantial number of people.
Before getting to my argument, a few examples.
Several weeks ago, I suggested that perhaps the New Jersey smoking law, by exempting casinos but banning smoking in the nearby bars in Atlantic City, would cause harm for those local bars by resulting in a loss of their smoking customers to casinos where smoking is still allowed. In addition, I suggested that this could increase secondhand smoke exposure for casino workers. Finally, I pointed out that the number of workers being denied protection - 48,000 - was substantial and that it should be acknowledged that this represented a flaw in the law that was due solely to a political compromise to appease the powerful casino lobby.
In contrast, some anti-smoking groups responded by ignoring the fact that casino workers were being denied protection and in one case of massive deception, misleading their constituents by suggesting that all workers were indeed being protected.
Recently I suggested that the District of Columbia's smoking ban was nonsensical because it provides a powerful incentive for restaurants to go into the tobacco sales business by exempting from the law establishments that can earn 10% or more of their revenues from tobacco sales. There is certainly no public health reasoning behind this policy. If secondhand smoke is a health hazard for bar and restaurant workers, then it is certainly no less of a hazard for those who work in establishments that derive 10% of their revenues from tobacco than those which do not.
And just yesterday, I questioned the rationality and justification behind the Oklahoma smoking law, which bans smoking in restaurants only if the business owner chooses not to allow smoking (in a separately ventilated smoking room) and which fails to protect bar workers from the alleged severe health effects of secondhand smoke. I suggested that for workers in those smoking rooms (even if it represents only a small proportion of overall restaurants), secondhand smoke exposure will be extremely high and certainly much higher than it is at present. In addition, smoke exposure in bars will be higher as smokers will shift somewhat from bars to restaurants.
In response, one commenter from Oklahoma refused to acknowledge that any harm would be caused by this law, and basically wrote off what he claimed would be the 2% of restaurants that do implement smoking rooms as well as 100% of the bars.
Please note that I am not necessarily taking issue here with public health advocates supporting these measures. Sometimes there are severe political constraints and perhaps it's the case that this is the "best" law that could be obtained. That is a strategic issue and I'm not necessarily questioning the strategic decisions made by these groups (at least not here).
However, what I am questioning is the complete reluctance (or should I say refusal) of many anti-smoking groups to simply admit that: (1) the policies are inconsistent and are not based on some rational public health justification; (2) the policies could do harm by increasing secondhand smoke exposure for some workers; and (3) the reason for the policy is not that it makes public health sense, but that certain politicians needed to be appeased in order to obtain their support.
What I'm pushing for here, then, is not different strategic decisions or for anti-smoking groups to necessarily reject proposals that are not "perfect," but instead, for simple honesty, transparency, and forthrightness in being willing to call a spade a spade and tell it like it is, rather than cloud the truth behind a veil of "this is a step in the right direction" rhetoric that ignores, dismisses, or hides the harm that these policies could do for some workers.
The Rest of the Story
There is no question, I think, that the Oklahoma smoking law is going to result in harm to some restaurant workers. For employees who work in the smoking rooms, they will be exposed to very high levels of secondhand smoke, and their exposure, on average, will increase by more than an order of magnitude.
It doesn't matter whether only a small proportion of restaurants build these smoking rooms. For those employees who work in them, it is going to increase their exposure. This means that if anti-smoking advocates are correct about the severe hazards of secondhand smoke, the Oklahoma law is going to cause health damage and disease (and possibly death) for a number of restaurant workers.
Now while it is my contention that we probably should not be supporting a public health policy that causes disease for some workers (in other words, that protects some workers at the expense of others), I recognize that it is possible that this provision in the law may have been the result of politics.
Fine. Then call a spade a spade, admit that it was solely politically motivated, and admit that the policy doesn't make sense and has no public health basis or rationale. That's all that I'm saying.
What possible harm could it do to be forthright and honest and admit that some workers are going to be harmed because of increased secondhand smoke exposure?
Now it was suggested yesterday that only 2% of restaurants in Oklahoma would fit into this category. First of all, we simply don't know what the proportion will be and so there is little basis to be able to determine the number of workers who will be affected.
But let's say that it is just 2%. Well, shouldn't we be forthright and admit that for that 2% of workers, the policy is going to result in health harm (or at least, in increased exposure to secondhand smoke)?
And if we discount or ignore the 2% of restaurants which will be smoke-filled, then the same reasoning could justify ignoring restaurants all together. In the desire to provide smoke-free workplaces for all employees, why worry about restaurants, which make up less than 2%, I believe, of all workplaces?
Moreover, while it may be 2% of all restaurants, it will likely be a much larger proportion of restaurants with high levels of smoke. Because the restaurants most likely to take on the expense of building a smoking room are precisely those with the most smokers (so that it would make sense to build a smoking room). Thus, it is precisely the workers who are most affected by secondhand smoke who will have to work in these smoke-filled smoking rooms.
In addition, by exempting bars, it is highly likely that many smokers will start hanging out less in restaurants, and more in bars. This would increase secondhand smoke exposure in bars. I don't think this is rhetoric. I think it's likely to be true, at least to some extent. Should we not be forthright and admit that this will likely occur, and that if it does, bar workers will face higher exposure and possibly, health harm?
Again, I'm not suggesting that health advocates not ever support exemptions or compromises. That's the process of policy making. But I do think we should be forthright about it and admit that yes, these policies are the result of compromises for political, rather than public health reasons and that yes, they will likely result in health damage for some workers.
One commenter yesterday posed the question: "If 98% of Oklahoma restaurants are smokefree, then what is the problem both with this policy other than the other 2% of the businesses have this smoking room?"
This is precisely my point. The problem is that 2% of businesses will expose their employees to an average of 10 times increased secondhand smoke exposure. Forget about any "other" problem. The comment seems to be ignoring or dismissing the very problem that I was trying to call attention to.
At very least, I think we need to be forthright and acknowledge that there is something quite irrational about a policy that protects the bulk of restaurant workers by having some of those workers face drastic increases in exposure to secondhand smoke and the resulting health damage.
OK - it may be the case that this provision was necessary for political purposes. Fine. But that doesn't mean we have to pretend that the policy makes public health sense. It doesn't, so what's wrong with simply admitting that?
Finally, I want to note that while I don't personally think that a smoking ban that creates a level playing field for all businesses will result in any economic harm, I do think there is strong reason to believe that an unequal playing field will benefit some establishments at the expense of others.
I don't think it is unreasonable to posit that establishments which can afford to install smoking rooms will be successful in attracting large numbers of smoking customers, possibly drawing them away from other businesses that simply cannot afford to build these smoking rooms. I don't think it is unreasonable, therefore, to suggest that in addition to health harm, the policy may cause some economic harm.
Don't get me wrong, I'm not suggesting that the economic harm outweighs health concerns. But I also don't see any damage caused by being honest and acknowledging that some restaurants may lose some customers due to this policy.
The rest of the story is that regardless of the rationale behind strategic decisions of anti-smoking groups to support restaurant smoking policies that are not "perfect," I think there is a need for groups to be more forthright about the lack of consistency in some of these policies, the lack of public health sense in some of these policies, and the very real fact that some of these policies will, if one accepts the scientific arguments of the policy proponents, result in increased secondhand smoke exposure and health damage for a number of workers, and possibly in economic harm for some establishments.
But the truth is that a number of smoking policies that some anti-smoking groups have supported do not make a whole lot of public health sense and would, in fact, cause harm to a substantial number of people.
Before getting to my argument, a few examples.
Several weeks ago, I suggested that perhaps the New Jersey smoking law, by exempting casinos but banning smoking in the nearby bars in Atlantic City, would cause harm for those local bars by resulting in a loss of their smoking customers to casinos where smoking is still allowed. In addition, I suggested that this could increase secondhand smoke exposure for casino workers. Finally, I pointed out that the number of workers being denied protection - 48,000 - was substantial and that it should be acknowledged that this represented a flaw in the law that was due solely to a political compromise to appease the powerful casino lobby.
In contrast, some anti-smoking groups responded by ignoring the fact that casino workers were being denied protection and in one case of massive deception, misleading their constituents by suggesting that all workers were indeed being protected.
Recently I suggested that the District of Columbia's smoking ban was nonsensical because it provides a powerful incentive for restaurants to go into the tobacco sales business by exempting from the law establishments that can earn 10% or more of their revenues from tobacco sales. There is certainly no public health reasoning behind this policy. If secondhand smoke is a health hazard for bar and restaurant workers, then it is certainly no less of a hazard for those who work in establishments that derive 10% of their revenues from tobacco than those which do not.
And just yesterday, I questioned the rationality and justification behind the Oklahoma smoking law, which bans smoking in restaurants only if the business owner chooses not to allow smoking (in a separately ventilated smoking room) and which fails to protect bar workers from the alleged severe health effects of secondhand smoke. I suggested that for workers in those smoking rooms (even if it represents only a small proportion of overall restaurants), secondhand smoke exposure will be extremely high and certainly much higher than it is at present. In addition, smoke exposure in bars will be higher as smokers will shift somewhat from bars to restaurants.
In response, one commenter from Oklahoma refused to acknowledge that any harm would be caused by this law, and basically wrote off what he claimed would be the 2% of restaurants that do implement smoking rooms as well as 100% of the bars.
Please note that I am not necessarily taking issue here with public health advocates supporting these measures. Sometimes there are severe political constraints and perhaps it's the case that this is the "best" law that could be obtained. That is a strategic issue and I'm not necessarily questioning the strategic decisions made by these groups (at least not here).
However, what I am questioning is the complete reluctance (or should I say refusal) of many anti-smoking groups to simply admit that: (1) the policies are inconsistent and are not based on some rational public health justification; (2) the policies could do harm by increasing secondhand smoke exposure for some workers; and (3) the reason for the policy is not that it makes public health sense, but that certain politicians needed to be appeased in order to obtain their support.
What I'm pushing for here, then, is not different strategic decisions or for anti-smoking groups to necessarily reject proposals that are not "perfect," but instead, for simple honesty, transparency, and forthrightness in being willing to call a spade a spade and tell it like it is, rather than cloud the truth behind a veil of "this is a step in the right direction" rhetoric that ignores, dismisses, or hides the harm that these policies could do for some workers.
The Rest of the Story
There is no question, I think, that the Oklahoma smoking law is going to result in harm to some restaurant workers. For employees who work in the smoking rooms, they will be exposed to very high levels of secondhand smoke, and their exposure, on average, will increase by more than an order of magnitude.
It doesn't matter whether only a small proportion of restaurants build these smoking rooms. For those employees who work in them, it is going to increase their exposure. This means that if anti-smoking advocates are correct about the severe hazards of secondhand smoke, the Oklahoma law is going to cause health damage and disease (and possibly death) for a number of restaurant workers.
Now while it is my contention that we probably should not be supporting a public health policy that causes disease for some workers (in other words, that protects some workers at the expense of others), I recognize that it is possible that this provision in the law may have been the result of politics.
Fine. Then call a spade a spade, admit that it was solely politically motivated, and admit that the policy doesn't make sense and has no public health basis or rationale. That's all that I'm saying.
What possible harm could it do to be forthright and honest and admit that some workers are going to be harmed because of increased secondhand smoke exposure?
Now it was suggested yesterday that only 2% of restaurants in Oklahoma would fit into this category. First of all, we simply don't know what the proportion will be and so there is little basis to be able to determine the number of workers who will be affected.
But let's say that it is just 2%. Well, shouldn't we be forthright and admit that for that 2% of workers, the policy is going to result in health harm (or at least, in increased exposure to secondhand smoke)?
And if we discount or ignore the 2% of restaurants which will be smoke-filled, then the same reasoning could justify ignoring restaurants all together. In the desire to provide smoke-free workplaces for all employees, why worry about restaurants, which make up less than 2%, I believe, of all workplaces?
Moreover, while it may be 2% of all restaurants, it will likely be a much larger proportion of restaurants with high levels of smoke. Because the restaurants most likely to take on the expense of building a smoking room are precisely those with the most smokers (so that it would make sense to build a smoking room). Thus, it is precisely the workers who are most affected by secondhand smoke who will have to work in these smoke-filled smoking rooms.
In addition, by exempting bars, it is highly likely that many smokers will start hanging out less in restaurants, and more in bars. This would increase secondhand smoke exposure in bars. I don't think this is rhetoric. I think it's likely to be true, at least to some extent. Should we not be forthright and admit that this will likely occur, and that if it does, bar workers will face higher exposure and possibly, health harm?
Again, I'm not suggesting that health advocates not ever support exemptions or compromises. That's the process of policy making. But I do think we should be forthright about it and admit that yes, these policies are the result of compromises for political, rather than public health reasons and that yes, they will likely result in health damage for some workers.
One commenter yesterday posed the question: "If 98% of Oklahoma restaurants are smokefree, then what is the problem both with this policy other than the other 2% of the businesses have this smoking room?"
This is precisely my point. The problem is that 2% of businesses will expose their employees to an average of 10 times increased secondhand smoke exposure. Forget about any "other" problem. The comment seems to be ignoring or dismissing the very problem that I was trying to call attention to.
At very least, I think we need to be forthright and acknowledge that there is something quite irrational about a policy that protects the bulk of restaurant workers by having some of those workers face drastic increases in exposure to secondhand smoke and the resulting health damage.
OK - it may be the case that this provision was necessary for political purposes. Fine. But that doesn't mean we have to pretend that the policy makes public health sense. It doesn't, so what's wrong with simply admitting that?
Finally, I want to note that while I don't personally think that a smoking ban that creates a level playing field for all businesses will result in any economic harm, I do think there is strong reason to believe that an unequal playing field will benefit some establishments at the expense of others.
I don't think it is unreasonable to posit that establishments which can afford to install smoking rooms will be successful in attracting large numbers of smoking customers, possibly drawing them away from other businesses that simply cannot afford to build these smoking rooms. I don't think it is unreasonable, therefore, to suggest that in addition to health harm, the policy may cause some economic harm.
Don't get me wrong, I'm not suggesting that the economic harm outweighs health concerns. But I also don't see any damage caused by being honest and acknowledging that some restaurants may lose some customers due to this policy.
The rest of the story is that regardless of the rationale behind strategic decisions of anti-smoking groups to support restaurant smoking policies that are not "perfect," I think there is a need for groups to be more forthright about the lack of consistency in some of these policies, the lack of public health sense in some of these policies, and the very real fact that some of these policies will, if one accepts the scientific arguments of the policy proponents, result in increased secondhand smoke exposure and health damage for a number of workers, and possibly in economic harm for some establishments.
Sunday, February 12, 2006
FORCES Sees What's Going On With Employment Discrimination Policies; Why Can't Anti-Smoking Organizations?
In a February 10 column, FORCES suggests to its readers that it is a disdain for smokers that is motivating the call by groups like Action on Smoking and Health (ASH) for employers to fire smokers and for employers to refuse to consider applications from smokers:
"Michael Siegel, an advocate for tobacco control has seen the light. After pondering what on earth Action on Smoking and Health hopes to accomplish by lobbying private business, and now state and local governments, to refuse to employ smokers he realizes the only logical motive is ... a disdain for the stubborn people who refuse to obey the orders of better and wiser people. It's important that those who do not hate, such as Siegel, speak out against the ugliness that has no place in what purports to be a charitable organization set up to educate the public."
As I argued in my posts of the past 2 weeks, I think FORCES is right. I simply have not seen, anywhere else in public health, the suggestion that an appropriate and effective way to improve the health of workers or to reduce business health costs is to fire people who don't behave in a certain healthful way.
You simply don't see public health groups calling on employers to fire fat people because they are at high risk of chronic disease and premature mortality and because businesses could save money by cleansing their workforce of obesity and because it's unfair to require thin and moderate-weight people to subsidize the health costs of fat people.
And you don't hear public health groups arguing that it's OK to fire fat people after giving them a chance to lose weight because most will decide to lose weight rather than risk being fired. Nor do you hear public health groups arguing that it's OK to refuse to hire fat people because it will serve as a fantastic incentive to get people to lose weight and most will do so if they really desire a particular job.
And, in fact, I'm not aware of any other legal health behavior (other than smoking) that doesn't directly affect job performance for which any public health group has ever called on employers to fire people with that health behavior or refuse to hire such people.
Can you imagine a public health group that is devoted to the obesity issue or to physical activity call on employers to fire anyone who is fat, or anyone who eats too much fat? Can you imagine a public health group devoted to preventing the complications of diabetes call on employers to fire workers who don't adequately control their blood sugars? Would any public health group that works on the issue of hypertension call on employers to fire workers who don't have adequately controlled blood pressure, or that such people not be hired in the first place?
It is simply beyond me that an anti-smoking group is acting in this inappropriate way, and I honestly cannot think of an adequate explanation other than that there is some disdain of smokers and some desire to punish them - in other words, that there is some hatred of smokers that is entering into the picture.
This is so contrary to my view of public health and tobacco control that it is difficult for me to reconcile. I came into medicine, public health, and tobacco control because I felt great compassion for my patients who were smokers and wanted to do something to help them and to prevent others from being in a similar situation.
So it is difficult for me to observe an anti-smoking group proceed with such a lack of compassion for smokers and with such a blatant disregard for basic public health standards of practice in order to pursue its narrow and overly zealous agenda.
My experience so far is that U.S. anti-smoking advocates and groups (unlike their British and Australian counterparts) have been defending and supporting ASH's actions, rather than condemning this aspect of ASH's agenda.
I wonder why it is that U.S. anti-smoking groups don't seem able to appreciate what FORCES and its members seem to understand - that at least part of the current anti-smoking agenda seems to be motivated not solely by pure public health concerns, but by an agenda that is at least in part separate from, and in conflict with, basic public health principles.
I'm glad that FORCES has been willing to consider and publicize my opinions on this issue, regardless of the difference of opinion that we have regarding many smoking bans, because at least the smokers out there who feel that policies such as those which discriminate against smokers in the workplace are not, in fact, supported by every anti-smoking advocate out here.
"Michael Siegel, an advocate for tobacco control has seen the light. After pondering what on earth Action on Smoking and Health hopes to accomplish by lobbying private business, and now state and local governments, to refuse to employ smokers he realizes the only logical motive is ... a disdain for the stubborn people who refuse to obey the orders of better and wiser people. It's important that those who do not hate, such as Siegel, speak out against the ugliness that has no place in what purports to be a charitable organization set up to educate the public."
The Rest of the Story
As I argued in my posts of the past 2 weeks, I think FORCES is right. I simply have not seen, anywhere else in public health, the suggestion that an appropriate and effective way to improve the health of workers or to reduce business health costs is to fire people who don't behave in a certain healthful way.
You simply don't see public health groups calling on employers to fire fat people because they are at high risk of chronic disease and premature mortality and because businesses could save money by cleansing their workforce of obesity and because it's unfair to require thin and moderate-weight people to subsidize the health costs of fat people.
And you don't hear public health groups arguing that it's OK to fire fat people after giving them a chance to lose weight because most will decide to lose weight rather than risk being fired. Nor do you hear public health groups arguing that it's OK to refuse to hire fat people because it will serve as a fantastic incentive to get people to lose weight and most will do so if they really desire a particular job.
And, in fact, I'm not aware of any other legal health behavior (other than smoking) that doesn't directly affect job performance for which any public health group has ever called on employers to fire people with that health behavior or refuse to hire such people.
Can you imagine a public health group that is devoted to the obesity issue or to physical activity call on employers to fire anyone who is fat, or anyone who eats too much fat? Can you imagine a public health group devoted to preventing the complications of diabetes call on employers to fire workers who don't adequately control their blood sugars? Would any public health group that works on the issue of hypertension call on employers to fire workers who don't have adequately controlled blood pressure, or that such people not be hired in the first place?
It is simply beyond me that an anti-smoking group is acting in this inappropriate way, and I honestly cannot think of an adequate explanation other than that there is some disdain of smokers and some desire to punish them - in other words, that there is some hatred of smokers that is entering into the picture.
This is so contrary to my view of public health and tobacco control that it is difficult for me to reconcile. I came into medicine, public health, and tobacco control because I felt great compassion for my patients who were smokers and wanted to do something to help them and to prevent others from being in a similar situation.
So it is difficult for me to observe an anti-smoking group proceed with such a lack of compassion for smokers and with such a blatant disregard for basic public health standards of practice in order to pursue its narrow and overly zealous agenda.
My experience so far is that U.S. anti-smoking advocates and groups (unlike their British and Australian counterparts) have been defending and supporting ASH's actions, rather than condemning this aspect of ASH's agenda.
I wonder why it is that U.S. anti-smoking groups don't seem able to appreciate what FORCES and its members seem to understand - that at least part of the current anti-smoking agenda seems to be motivated not solely by pure public health concerns, but by an agenda that is at least in part separate from, and in conflict with, basic public health principles.
I'm glad that FORCES has been willing to consider and publicize my opinions on this issue, regardless of the difference of opinion that we have regarding many smoking bans, because at least the smokers out there who feel that policies such as those which discriminate against smokers in the workplace are not, in fact, supported by every anti-smoking advocate out here.
Oklahoma Restaurants Must Become Smoke-Free or Smoke-Filled by March 1; When Will this Stupidity End?
As of March 1, 2006, all restaurants in Oklahoma will have a choice: (1) become smoke-free and protect all their workers from secondhand smoke exposure; or (2) create smoke-filled rooms and expose their employees to extremely high levels of secondhand smoke.
The restaurant provisions of Oklahoma's Smoking in Public Places and Indoor Workplaces Act become effective in just 2 weeks. Although the law initially went into effect in September 2003, restaurants were exempt from the law until March 1, 2006, at which time they may either eliminate smoking completely, or restrict it to enclosed, separately ventilated rooms of any size. Bars are permanently exempt from the state law, which preempts any local regulation of smoking in bars, restaurants, workplaces, or public places.
In a state Department of Health press release issued to inform restaurants of their options and explain the reasons behind the law, the State Health Commissioner explained: "We applaud and thank the restaurants that have become entirely smokefree ahead of the legal deadline of March 1, 2006. For the health of their employees and patrons, we strongly encourage all others to do so as quickly as possible. Smokefree environments benefit the health of employees and customers alike... ."
The State Health Commissioner noted that "although a restaurant may be permitted to create a smoking room under Oklahoma'’s new laws, such rooms are typically costly to build and to operate, and a smoking room would still subject employees and patrons alike to hazardous secondhand smoke exposure."
The Rest of the Story
In their infinite wisdom, legislators in Oklahoma have decided that secondhand smoke is a severe enough hazard for restaurant workers who are exposed to moderate levels so that smoking must be banned, but not severe enough for restaurant workers who are exposed to extremely high levels who will not be touched by the legislation.
Evidence demonstrates that levels of secondhand smoke in enclosed, separately ventilated rooms are, on average, more than 10 times higher than in restaurants where smoking is allowed anywhere (see: Siegel M, Husten C, Merritt R, Giovino G, Eriksen M: The health effects of separately ventilated smoking lounges on smokers: Is this an appropriate public health policy? Tobacco Control 1995; 4:22-29).
Thus, from a public health standpoint, it is far better to not regulate smoking at all in restaurants than it is to restrict it to separately ventilated rooms. While exposure among restaurant workers in establishments that allow smoking is relatively low (at least compared to smoking rooms), levels of exposure in smoking rooms are astronomical. Average nicotine levels are only about 6 ug/m3 in a restaurant that allows smoking, but 70 ug/m3 in a separately ventilated smoking room.
In fact, I have estimated that, assuming a relative risk of about 1.3 for the effect of secondhand smoke on lung cancer risk, restricting smoking to separately ventilated areas would likely result in an increase in lung cancer deaths in the population. This is because any gains from reducing secondhand smoke exposure among workers will be far more than offset by the losses due to increased secondhand smoke exposure of those in the smoke-filled smoking rooms.
While it is true that many restaurants may decide not to take on the expense of creating a separately ventilated smoking room, the state has no control over that. It is entirely possible that many restaurants will take advantage of this opportunity to continue catering to their smoking patrons, especially if it is true that smoking bans lead to decreases in revenue for restaurants.
If secondhand smoke is a hazard that requires a legislated solution, then it requires a legislated solution. And if it doesn't require a legislated solution, then it doesn't. This Oklahoma public policy makes no sense at all.
Moreover, public health advocates who supported this legislation cannot argue either that: (1) the state will simply strengthen the law in the future; or (2) localities will enact stronger laws. The former is unlikely, because once restaurant owners install expensive ventilation systems, it is unfair to require them to go totally smoke-free. The latter is not possible because of the preemption in the law.
Interestingly, there is no size limit on the allowed smoking rooms in restaurants. So a restaurant could essentially create a separately ventilated room that takes up most of the establishment, as long as it provides at least a few nonsmoking seats outside of that room. This is a method by which any restaurant could essentially skirt the law if it wants to. Just create a very small separately ventilated area for nonsmokers and then as long as it is enclosed, the rest of the restaurant can be allocated to smoking and non-smoking however the restaurant owner desires.
If secondhand smoke is as bad for workers as the Oklahoma legislature apparently feels (by virtue of their exercising the state's police powers to regulate the conduct of private businesses), then there is simply no public health logic to allowing workers to be exposed to extremely high levels of secondhand smoke in smoking rooms.
Without question, this law is going to increase secondhand smoke exposure for a number of workers in Oklahoma. And that number is totally up to the restaurant owners in the state. The legislature has absolutely no control over the health of the state's restaurant workers. They have abdicated responsibility over this health hazard to the whim of restaurant owners. To me, that's not public health. That's stupidity.
The restaurant provisions of Oklahoma's Smoking in Public Places and Indoor Workplaces Act become effective in just 2 weeks. Although the law initially went into effect in September 2003, restaurants were exempt from the law until March 1, 2006, at which time they may either eliminate smoking completely, or restrict it to enclosed, separately ventilated rooms of any size. Bars are permanently exempt from the state law, which preempts any local regulation of smoking in bars, restaurants, workplaces, or public places.
In a state Department of Health press release issued to inform restaurants of their options and explain the reasons behind the law, the State Health Commissioner explained: "We applaud and thank the restaurants that have become entirely smokefree ahead of the legal deadline of March 1, 2006. For the health of their employees and patrons, we strongly encourage all others to do so as quickly as possible. Smokefree environments benefit the health of employees and customers alike... ."
The State Health Commissioner noted that "although a restaurant may be permitted to create a smoking room under Oklahoma'’s new laws, such rooms are typically costly to build and to operate, and a smoking room would still subject employees and patrons alike to hazardous secondhand smoke exposure."
The Rest of the Story
In their infinite wisdom, legislators in Oklahoma have decided that secondhand smoke is a severe enough hazard for restaurant workers who are exposed to moderate levels so that smoking must be banned, but not severe enough for restaurant workers who are exposed to extremely high levels who will not be touched by the legislation.
Evidence demonstrates that levels of secondhand smoke in enclosed, separately ventilated rooms are, on average, more than 10 times higher than in restaurants where smoking is allowed anywhere (see: Siegel M, Husten C, Merritt R, Giovino G, Eriksen M: The health effects of separately ventilated smoking lounges on smokers: Is this an appropriate public health policy? Tobacco Control 1995; 4:22-29).
Thus, from a public health standpoint, it is far better to not regulate smoking at all in restaurants than it is to restrict it to separately ventilated rooms. While exposure among restaurant workers in establishments that allow smoking is relatively low (at least compared to smoking rooms), levels of exposure in smoking rooms are astronomical. Average nicotine levels are only about 6 ug/m3 in a restaurant that allows smoking, but 70 ug/m3 in a separately ventilated smoking room.
In fact, I have estimated that, assuming a relative risk of about 1.3 for the effect of secondhand smoke on lung cancer risk, restricting smoking to separately ventilated areas would likely result in an increase in lung cancer deaths in the population. This is because any gains from reducing secondhand smoke exposure among workers will be far more than offset by the losses due to increased secondhand smoke exposure of those in the smoke-filled smoking rooms.
While it is true that many restaurants may decide not to take on the expense of creating a separately ventilated smoking room, the state has no control over that. It is entirely possible that many restaurants will take advantage of this opportunity to continue catering to their smoking patrons, especially if it is true that smoking bans lead to decreases in revenue for restaurants.
If secondhand smoke is a hazard that requires a legislated solution, then it requires a legislated solution. And if it doesn't require a legislated solution, then it doesn't. This Oklahoma public policy makes no sense at all.
Moreover, public health advocates who supported this legislation cannot argue either that: (1) the state will simply strengthen the law in the future; or (2) localities will enact stronger laws. The former is unlikely, because once restaurant owners install expensive ventilation systems, it is unfair to require them to go totally smoke-free. The latter is not possible because of the preemption in the law.
Interestingly, there is no size limit on the allowed smoking rooms in restaurants. So a restaurant could essentially create a separately ventilated room that takes up most of the establishment, as long as it provides at least a few nonsmoking seats outside of that room. This is a method by which any restaurant could essentially skirt the law if it wants to. Just create a very small separately ventilated area for nonsmokers and then as long as it is enclosed, the rest of the restaurant can be allocated to smoking and non-smoking however the restaurant owner desires.
If secondhand smoke is as bad for workers as the Oklahoma legislature apparently feels (by virtue of their exercising the state's police powers to regulate the conduct of private businesses), then there is simply no public health logic to allowing workers to be exposed to extremely high levels of secondhand smoke in smoking rooms.
Without question, this law is going to increase secondhand smoke exposure for a number of workers in Oklahoma. And that number is totally up to the restaurant owners in the state. The legislature has absolutely no control over the health of the state's restaurant workers. They have abdicated responsibility over this health hazard to the whim of restaurant owners. To me, that's not public health. That's stupidity.
IN MY VIEW: ASH Calling on Taxpayers to Shoulder the Health Care Burden of Smoking
In prior posts (post 1; post 2; post 3; post 4; post 5; post 6; post 7), I have argued against ASH's call for employers to fire smokers and to not hire smokers in order to save money and reduce the burden on nonsmokers of subsidizing health care for smokers based on my contention that such policies are unjustified, inappropriate, and improper.
Here, I argue that such policies would not even be effective in doing what ASH purports they will do: reduce the burden on nonsmokers of subsidizing health care costs for smokers.
The Rest of the Story
The rest of the story is that what ASH apparently fails to see is that when smokers are fired from their jobs, they not only lose their jobs. They also lose something else: health insurance.
Now somebody else has to pay for the health care costs that smokers are going to face. And if it's not going to be insurance companies, then who is it going to be? The answer is: taxpayers.
Because we do not (yet) deny medical treatment to smokers, the overall health costs to society are not going to be drastically reduced. What the policy that ASH is calling for would do, then, is to simply shift the burden of paying these costs from one place to the other.
Essentially, what ASH's recommended policy would do is shift the costs from health insurance companies to taxpayers. Because smokers whose health insurance is taken away will largely need to be covered by Medicaid or by free care, the costs will be borne by taxpayers and to some extent, by overall increases in medical care for everyone because of the need to compensate hospitals for free care.
ASH's thinking, in addition to being uncompassionate and cruel, is quite short-sighted. True, employers would not be burdened with the costs of medical treatment for smokers. But somebody would - and that somebody is the taxpayers.
If 20% of our population was suddenly (or even gradually) unemployed, it would create a huge burden on government-provided health insurance. Being the single largest source of government expenditures, this would harm state budgets and create a need for increased taxes to offset the expenditures. In addition, since insurance companies would be paying less of the costs to treat smokers, citizens would have to shoulder more of this burden. Likely, health care costs would rise.
The one group that stands to benefit most from ASH's proposed policy is the insurance companies. They could only dream of such a wonderful proposal. Get all smokers off of their backs by denying them health insurance. The companies could never get away with such a disgusting action. But they don't have to: ASH is attempting to accomplish this for them.
While some have suggested that there is a huge difference between policies that deny smokers employment, and policies that deny smokers health care, I really don't think the difference is as large as many think.
Ultimately, denying employment to smokers is tantamount to denying health insurance to smokers, since most insurance in this country is employer-provided and unemployed smokers will almost certainly not be able to afford private insurance.
If what is really going on here is that we are denying health insurance to smokers, then it is only one small step from there to deny medical care to smokers. Because if we don't deny them medical care, then the benefits of taking away their health insurance will not be realized (they will simply be covered under the government's health insurance or under free care).
And when it is the already strapped-for-cash taxpayers who are shouldering the burden of medical care for smokers, rather than the insurance companies, you can bet that the climate which resulted in a quick rejection of Senator Teck's proposal to deny medical care to smokers will quickly change.
The rest of the story is that ASH's claim that denying employment to smokers will help ease the burden on nonsmokers of subsidizing the health care costs of smokers is wrong. What it will really do is simply shift the burden of paying for treatment of smokers from insurance companies to taxpayers. Personally, I'd rather have the insurance companies pay.
Here, I argue that such policies would not even be effective in doing what ASH purports they will do: reduce the burden on nonsmokers of subsidizing health care costs for smokers.
The Rest of the Story
The rest of the story is that what ASH apparently fails to see is that when smokers are fired from their jobs, they not only lose their jobs. They also lose something else: health insurance.
Now somebody else has to pay for the health care costs that smokers are going to face. And if it's not going to be insurance companies, then who is it going to be? The answer is: taxpayers.
Because we do not (yet) deny medical treatment to smokers, the overall health costs to society are not going to be drastically reduced. What the policy that ASH is calling for would do, then, is to simply shift the burden of paying these costs from one place to the other.
Essentially, what ASH's recommended policy would do is shift the costs from health insurance companies to taxpayers. Because smokers whose health insurance is taken away will largely need to be covered by Medicaid or by free care, the costs will be borne by taxpayers and to some extent, by overall increases in medical care for everyone because of the need to compensate hospitals for free care.
ASH's thinking, in addition to being uncompassionate and cruel, is quite short-sighted. True, employers would not be burdened with the costs of medical treatment for smokers. But somebody would - and that somebody is the taxpayers.
If 20% of our population was suddenly (or even gradually) unemployed, it would create a huge burden on government-provided health insurance. Being the single largest source of government expenditures, this would harm state budgets and create a need for increased taxes to offset the expenditures. In addition, since insurance companies would be paying less of the costs to treat smokers, citizens would have to shoulder more of this burden. Likely, health care costs would rise.
The one group that stands to benefit most from ASH's proposed policy is the insurance companies. They could only dream of such a wonderful proposal. Get all smokers off of their backs by denying them health insurance. The companies could never get away with such a disgusting action. But they don't have to: ASH is attempting to accomplish this for them.
While some have suggested that there is a huge difference between policies that deny smokers employment, and policies that deny smokers health care, I really don't think the difference is as large as many think.
Ultimately, denying employment to smokers is tantamount to denying health insurance to smokers, since most insurance in this country is employer-provided and unemployed smokers will almost certainly not be able to afford private insurance.
If what is really going on here is that we are denying health insurance to smokers, then it is only one small step from there to deny medical care to smokers. Because if we don't deny them medical care, then the benefits of taking away their health insurance will not be realized (they will simply be covered under the government's health insurance or under free care).
And when it is the already strapped-for-cash taxpayers who are shouldering the burden of medical care for smokers, rather than the insurance companies, you can bet that the climate which resulted in a quick rejection of Senator Teck's proposal to deny medical care to smokers will quickly change.
The rest of the story is that ASH's claim that denying employment to smokers will help ease the burden on nonsmokers of subsidizing the health care costs of smokers is wrong. What it will really do is simply shift the burden of paying for treatment of smokers from insurance companies to taxpayers. Personally, I'd rather have the insurance companies pay.
Friday, February 10, 2006
First Calabasas and Melbourne, Next the World: ASH Calls on International Bans on Smokers in the Workplace and Outdoors Smoking
If Action on Smoking and Health (ASH) has its way, smokers will not be able to obtain jobs not only anywhere in Melbourne, but anywhere in the world. And they won't only be unable to smoke on streets, sidewalks, and parking lots in Calabasas, but anywhere on earth.
In a press release issued today, ASH announced that it was providing delegates from countries all over the globe with literature it prepared which apparently is designed to try to convince them to enact widespread smoking bans that include all outdoors places and to encourage them to adopt policies by which smokers are fired from their jobs and precluded from obtaining employment at any workplace.
The material provided to delegates at the initial Framework Convention on Tobacco Control (FCTC) conference in Geneva asks: "How far can we go in cracking down on smoking without some kind of backlash? The U.S. provides one example. One city has voted to ban smoking outdoors in virtually all areas -- including public sidewalks and streets, and on restaurants' outdoor smoking patios. At open public hearings, no company and no smoker testified against the bill, not a single editorial opposed it, and many antismoking groups have praised it.
More than 700 other jurisdictions -- including the entire State of Washington -- have already banned smoking in some outdoor areas: e.g., beaches, parks, waiting lines, near building entrances, etc. In at least eighteen states, courts have issued orders prohibiting smoking in the homes and cars of children involved in custody disputes, and/or limited custody of parents smoking around children. Four states have already banned smoking in homes and cars when foster children are present, and many are preparing to do so. At hearings there is no opposition, and foster care associations support such measures.
A Florida city -- like many private companies -- is proposing to hire only nonsmokers in order to save almost $10,000 [US] annually per employee. Scotts Miracle Gro says it will fire employees who smoke on or off the job, a move a major TV network [CBS] said may be a "national model" and a "new reality."” While these measures may not yet be appropriate in all countries, tobacco control advocates should not worry needlessly about a backlash.
There was no backlash when smoking was banned on most airline flights, when entire countries banned smoking in virtually all public places including bars/pubs, etc.
Since the U.S. experience shows that aggressive antismoking measures are increasingly gaining public support, advocates should not be timid in proposing them."
The Rest of the Story
I've been observing (from the inside) the tobacco control movement for 21 years, and in my opinion, I do think there is going to be a backlash if we move in the direction ASH would have us go, and it's going to be a huge one.
ASH may not realize it, but an anti-smoking organization of the same name in the UK has already come out and condemned the policy of not hiring smokers. Good luck getting the public in Great Britain to support discriminatory hiring policies against smokers when the major anti-smoking group in the country has publicly condemned the policy.
A prominent tobacco control advocate in Australia has also spoken out against these discriminatory policies.
I think ASH is going to find a huge difference in public sentiment and sentiment among the tobacco control community itself when it leaves the "friendly" confines of the U.S. and takes its crusade to the rest of the world.
Anti-smoking groups in the U.S. may be unwilling to speak out against these illegitimate public policies, but not so for at least some organizations in other countries.
But that's not what this post is about.
This post is about what the heck is motivating ASH to intervene in employment policies throughout the world? What business is it of ASH's to tell employers in other countries what to do in terms of who they hire?
If the motivation is to try to reduce health care costs and save money for employers throughout the world, then it seems quite inappropriate, since ASH's mission has nothing to do with saving money for employers.
Plus, if it was sincere about its efforts to save health care spending for employers, it would most certainly want to advocate not hiring fat people, since employer health care costs associated with obesity may well exceed costs associated with smoking and it is certainly highly "discriminatory" for thin and "normal-weight" people to have to subsidize costs for fat people who made the unwise choice to sit around and eat fatty foods, including tater tots. (I'm starting a new organization: Stop Workplace Discrimination Against Non-Tater Tot Eaters - by the way, has anyone tried the recipe yet?).
A second possible motivation might be simply the desire to reduce smoking. In other words, ASH might view firing smokers and refusing to hire them as a smoking reduction intervention. If that's the case, then I find it even more problematic, because I think it's inappropriate to use firing people as a workplace health promotion strategy.
I suppose that a third possible motivation is a desire to punish smokers for what ASH perceives is making an "unwise choice." If I had to be punished for every unwise choice I've made, I'd be grounded for life.
Unfortunately, I don't find what ASH is doing to be funny. This is really serious, and it truly threatens the credibility and legitimacy of the tobacco control movement, now not only in the United States, but throughout the world. Moreover, it threatens to turn smokers into second-class citizens who do not have the same employment opportunities as the "rest" of us.
The rest of the story suggests that a leading anti-smoking group is now taking its message of hate against smokers to the rest of the world: eventually, all countries, it is hoped, will make smokers second-class citizens who cannot obtain employment and make a living. But that's apparently OK, because it's being done for their own good. They deserve it, because they've made such an unwise choice and they need to be punished.
Good luck, ASH - U.S.! Just don't try to take me along with you, because I'm not coming along for the ride.
In a press release issued today, ASH announced that it was providing delegates from countries all over the globe with literature it prepared which apparently is designed to try to convince them to enact widespread smoking bans that include all outdoors places and to encourage them to adopt policies by which smokers are fired from their jobs and precluded from obtaining employment at any workplace.
The material provided to delegates at the initial Framework Convention on Tobacco Control (FCTC) conference in Geneva asks: "How far can we go in cracking down on smoking without some kind of backlash? The U.S. provides one example. One city has voted to ban smoking outdoors in virtually all areas -- including public sidewalks and streets, and on restaurants' outdoor smoking patios. At open public hearings, no company and no smoker testified against the bill, not a single editorial opposed it, and many antismoking groups have praised it.
More than 700 other jurisdictions -- including the entire State of Washington -- have already banned smoking in some outdoor areas: e.g., beaches, parks, waiting lines, near building entrances, etc. In at least eighteen states, courts have issued orders prohibiting smoking in the homes and cars of children involved in custody disputes, and/or limited custody of parents smoking around children. Four states have already banned smoking in homes and cars when foster children are present, and many are preparing to do so. At hearings there is no opposition, and foster care associations support such measures.
A Florida city -- like many private companies -- is proposing to hire only nonsmokers in order to save almost $10,000 [US] annually per employee. Scotts Miracle Gro says it will fire employees who smoke on or off the job, a move a major TV network [CBS] said may be a "national model" and a "new reality."” While these measures may not yet be appropriate in all countries, tobacco control advocates should not worry needlessly about a backlash.
There was no backlash when smoking was banned on most airline flights, when entire countries banned smoking in virtually all public places including bars/pubs, etc.
Since the U.S. experience shows that aggressive antismoking measures are increasingly gaining public support, advocates should not be timid in proposing them."
The Rest of the Story
I've been observing (from the inside) the tobacco control movement for 21 years, and in my opinion, I do think there is going to be a backlash if we move in the direction ASH would have us go, and it's going to be a huge one.
ASH may not realize it, but an anti-smoking organization of the same name in the UK has already come out and condemned the policy of not hiring smokers. Good luck getting the public in Great Britain to support discriminatory hiring policies against smokers when the major anti-smoking group in the country has publicly condemned the policy.
A prominent tobacco control advocate in Australia has also spoken out against these discriminatory policies.
I think ASH is going to find a huge difference in public sentiment and sentiment among the tobacco control community itself when it leaves the "friendly" confines of the U.S. and takes its crusade to the rest of the world.
Anti-smoking groups in the U.S. may be unwilling to speak out against these illegitimate public policies, but not so for at least some organizations in other countries.
But that's not what this post is about.
This post is about what the heck is motivating ASH to intervene in employment policies throughout the world? What business is it of ASH's to tell employers in other countries what to do in terms of who they hire?
If the motivation is to try to reduce health care costs and save money for employers throughout the world, then it seems quite inappropriate, since ASH's mission has nothing to do with saving money for employers.
Plus, if it was sincere about its efforts to save health care spending for employers, it would most certainly want to advocate not hiring fat people, since employer health care costs associated with obesity may well exceed costs associated with smoking and it is certainly highly "discriminatory" for thin and "normal-weight" people to have to subsidize costs for fat people who made the unwise choice to sit around and eat fatty foods, including tater tots. (I'm starting a new organization: Stop Workplace Discrimination Against Non-Tater Tot Eaters - by the way, has anyone tried the recipe yet?).
A second possible motivation might be simply the desire to reduce smoking. In other words, ASH might view firing smokers and refusing to hire them as a smoking reduction intervention. If that's the case, then I find it even more problematic, because I think it's inappropriate to use firing people as a workplace health promotion strategy.
I suppose that a third possible motivation is a desire to punish smokers for what ASH perceives is making an "unwise choice." If I had to be punished for every unwise choice I've made, I'd be grounded for life.
Unfortunately, I don't find what ASH is doing to be funny. This is really serious, and it truly threatens the credibility and legitimacy of the tobacco control movement, now not only in the United States, but throughout the world. Moreover, it threatens to turn smokers into second-class citizens who do not have the same employment opportunities as the "rest" of us.
The rest of the story suggests that a leading anti-smoking group is now taking its message of hate against smokers to the rest of the world: eventually, all countries, it is hoped, will make smokers second-class citizens who cannot obtain employment and make a living. But that's apparently OK, because it's being done for their own good. They deserve it, because they've made such an unwise choice and they need to be punished.
Good luck, ASH - U.S.! Just don't try to take me along with you, because I'm not coming along for the ride.
Anti-Smoking Group Seems Inconsistent and Insincere in Defending Smoking Ban Exemptions
An anti-smoking group in Scotland yesterday defended the exemptions in the Scottish smoking ban, which goes into effect on March 26, suggesting that there is a good reason behind each of the exemptions in the ban.
According to an article in the Scotsman, ASH-Scotland responded to questioning of the justification behind certain smoking ban exemptions by stating: "The very few exemptions have been carefully debated and are there for good reasons."
The smoking ban, which will eliminate smoking in almost all workplaces, including restaurants and pubs, provides exemptions for "designated rooms in adult care homes," "designated rooms in psychiatric hospitals," and "detention or police interview rooms."
The Rest of the Story
I don't see any way that a public health advocate who supports a ban on smoking in workplaces and public places can possibly justify exemptions that would allow smoking in nursing homes, psychiatric hospitals, and police stations. And if there are good reasons to ban smoking in pubs, then I certainly do not think there are good reasons not to ban smoking in these other indoor workplaces, where both workers and "clients/patients" are present for long periods of time and cannot escape exposure to the smoke.
If secondhand smoke is so hazardous that we cannot allow pub workers to be exposed (or patrons at pubs), then how could it be safe for confined elderly people, mentally ill people, or police officers to breathe?
Is this not discriminating against the elderly, the mentally ill, and police officers in making them not subject to the same health protection that other citizens are offered? Does this not suggest that we are somehow deeming these individuals less worthy of health protection?
Don't the mentally ill deserve the same level of protection as the rest of us, and isn't it degrading to them to suggest that they don't?
While I am not necessarily arguing here either for or against any particular exemptions in the Scotland law, what I am trying to point out is that it is simply inconsistent public health policy, and quite unjustified on public health grounds, to provide protection to some people but to deny that protection to others, especially when the group you are denying protection to is largely unable to defend themselves.
Many mentally ill and elderly residents of nursing homes and psychiatric hospitals are not competent enough to be able to protect themselves, or to lobby for their own health protection. Is it fair and just to deny them health protection that we as public health practitioners are arguing that everyone else deserves?
My point is simply that no matter how one feels about smoking bans (whether one believes that smoking bans anywhere are unjustified or that smoking bans everywhere are justified), it seems one would have to agree that this policy makes no public health sense.
I therefore question the contention that the exemptions in the smoking ban are justified and there for good reasons. They are not there for any possible public health reason. They make no public health sense, are unjustified from a public health perspective, and result in a public health policy that is inconsistent, with unequal application of public health protection to different groups.
The law creates an unlevel playing field, discriminates against certain (largely helpless and politically less powerful) groups in denying them health protection that is afforded to everyone else, and basically cannot make up its mind whether secondhand smoke is indeed harmful or not.
I would add that this law bans smoking in any enclosed outdoor area, including, it appears, an outdoor smoking area!
Even if 49% of an outdoor smoking area is open, you cannot smoke in it. But you can smoke up a storm when being interrogated by the police to find out why you were smoking outdoors in a smokers' shelter. And you can also smoke when sent to a psychiatric hospital because the blatant hypocrisy of the smoking ban's provisions makes you mad. And you can't smoke in the cab or van that takes you to your nursing home, but as soon as you get there, light up and enjoy!
I'm sorry, but there is no way that an anti-smoking group can or should attempt to defend the rationality of these smoking ban exemptions.
And it is for this reason that I question the sincerity, as well as the lack of consistency, of the anti-smoking groups that are defending these exemptions.
I have no problem with these groups simply admitting that the policies are inconsistent, that the stupidities within the policy are present because they were needed for political reasons (to garner enough votes or support to get the policy through).
But don't pretend that there is some logical, reasonable public health rationale for forcing people to be involuntarily exposed to a hazard that you yourself have declared is so toxic and so hazardous that you cannot even allow smokers to be exposed to in outdoors areas that are no more than 49% open.
That is not, in my view, being sincere. That's simply not being forthright enough to admit that the exemptions are the result of political compromises, not any sort of sound, public health reasoning.
According to an article in the Scotsman, ASH-Scotland responded to questioning of the justification behind certain smoking ban exemptions by stating: "The very few exemptions have been carefully debated and are there for good reasons."
The smoking ban, which will eliminate smoking in almost all workplaces, including restaurants and pubs, provides exemptions for "designated rooms in adult care homes," "designated rooms in psychiatric hospitals," and "detention or police interview rooms."
The Rest of the Story
I don't see any way that a public health advocate who supports a ban on smoking in workplaces and public places can possibly justify exemptions that would allow smoking in nursing homes, psychiatric hospitals, and police stations. And if there are good reasons to ban smoking in pubs, then I certainly do not think there are good reasons not to ban smoking in these other indoor workplaces, where both workers and "clients/patients" are present for long periods of time and cannot escape exposure to the smoke.
If secondhand smoke is so hazardous that we cannot allow pub workers to be exposed (or patrons at pubs), then how could it be safe for confined elderly people, mentally ill people, or police officers to breathe?
Is this not discriminating against the elderly, the mentally ill, and police officers in making them not subject to the same health protection that other citizens are offered? Does this not suggest that we are somehow deeming these individuals less worthy of health protection?
Don't the mentally ill deserve the same level of protection as the rest of us, and isn't it degrading to them to suggest that they don't?
While I am not necessarily arguing here either for or against any particular exemptions in the Scotland law, what I am trying to point out is that it is simply inconsistent public health policy, and quite unjustified on public health grounds, to provide protection to some people but to deny that protection to others, especially when the group you are denying protection to is largely unable to defend themselves.
Many mentally ill and elderly residents of nursing homes and psychiatric hospitals are not competent enough to be able to protect themselves, or to lobby for their own health protection. Is it fair and just to deny them health protection that we as public health practitioners are arguing that everyone else deserves?
My point is simply that no matter how one feels about smoking bans (whether one believes that smoking bans anywhere are unjustified or that smoking bans everywhere are justified), it seems one would have to agree that this policy makes no public health sense.
I therefore question the contention that the exemptions in the smoking ban are justified and there for good reasons. They are not there for any possible public health reason. They make no public health sense, are unjustified from a public health perspective, and result in a public health policy that is inconsistent, with unequal application of public health protection to different groups.
The law creates an unlevel playing field, discriminates against certain (largely helpless and politically less powerful) groups in denying them health protection that is afforded to everyone else, and basically cannot make up its mind whether secondhand smoke is indeed harmful or not.
I would add that this law bans smoking in any enclosed outdoor area, including, it appears, an outdoor smoking area!
Even if 49% of an outdoor smoking area is open, you cannot smoke in it. But you can smoke up a storm when being interrogated by the police to find out why you were smoking outdoors in a smokers' shelter. And you can also smoke when sent to a psychiatric hospital because the blatant hypocrisy of the smoking ban's provisions makes you mad. And you can't smoke in the cab or van that takes you to your nursing home, but as soon as you get there, light up and enjoy!
I'm sorry, but there is no way that an anti-smoking group can or should attempt to defend the rationality of these smoking ban exemptions.
And it is for this reason that I question the sincerity, as well as the lack of consistency, of the anti-smoking groups that are defending these exemptions.
I have no problem with these groups simply admitting that the policies are inconsistent, that the stupidities within the policy are present because they were needed for political reasons (to garner enough votes or support to get the policy through).
But don't pretend that there is some logical, reasonable public health rationale for forcing people to be involuntarily exposed to a hazard that you yourself have declared is so toxic and so hazardous that you cannot even allow smokers to be exposed to in outdoors areas that are no more than 49% open.
That is not, in my view, being sincere. That's simply not being forthright enough to admit that the exemptions are the result of political compromises, not any sort of sound, public health reasoning.
Thursday, February 09, 2006
Anti-Smoking Group Urges Cities to Ban Smokers from Employment
A prominent anti-smoking group -- Action on Smoking and Health (ASH) -- is urging cities to ban smokers from employment in order to save on health care costs. In a press release issued today, ASH announced that it was intervening in Melbourne (Florida) to encourage the city to throw job applications from smokers in the trash, regardless of any other individual qualifications they may have for employment with the city of Melbourne.
According to the press release, entitled "Melbourne May Ban Off-the-Job Smoking by Employees; ASH Urges City to Act to Save 25% or More in Smoking-Related Costs," a workplace smoker ban is effective and appropriate because it would save money for the city as well as end "discrimination" against "the overwhelming majority of workers who have wisely chosen not to smoke by forcing them to assume -- directly or indirectly -- the costs of smoking."
The Rest of the Story
I consider February 9, 2006 to be an important date in tobacco control history. It marks the date that the anti-smoking movement officially went on record as supporting bans on smokers in the workplace.
My previous post, in which I suggested that ASH was encouraging employers to fire smokers, was met with some skepticism about whether ASH was actively encouraging such policies or merely trying to educate the public about the legality of doing so. It is now eminently clear that ASH was, and is, actively promoting such policies, and going so far as to intervene in the public policy deliberations of employers: in this case, the city of Melbourne.
While ASH is the only anti-smoking group that is actively promoting these policies, I am aware of no U.S. anti-smoking group that has publicly opposed these policies. Thus, as far as I'm concerned, the anti-smoking movement in the U.S. is officially on record as supporting these policies.
Those who are familiar with my commentaries know that I support workplace smoking bans. But I do not support workplace smoker bans. And there is a huge difference.
The ultimate irony is that ASH calls the fact that nonsmokers may bear increased health care costs because of smokers "discrimination," yet fails to appreciate that the policy it is proposing is actually a form of institutionalized employment discrimination.
Frankly, it is not discrimination (and it is an insult to the term discrimination) to use that term to describe the increased burden of health care costs that fall on nonsmokers. One could just as easily argue that thin people are discriminated against because they bear the costs of treating illnesses among fat people, or that vegetarians are discriminated against because they subsidize the costs of treating people who eat high-fat diets, or that non-bungee-jumpers are discriminated against because they have to subsidize the health care costs of treating bungee jumping injuries.
But it is truly employment discrimination to refuse to consider applications from smokers simply because of the category to which they belong, rather than based on any individual qualifications for employment (which cannot possibly be considered if their applications are immediately thrown in the trash based solely on the fact that they admit smoking off-the-job).
In my workplace, it is indisputably true that the major source of increased health care costs are employees, like myself, who have young children. We are sicker more, especially during the winter, and my co-workers without young children are bearing the burden of our increased illness.
By ASH's reasoning, my co-workers without young children are being discriminated against, and I should be fired. And I guess I should have been fired 4 years ago, when my first child was born. Or maybe they should have asked if I planned to have children when I first applied, and thrown my application in the garbage right then and there. Then all these problems and the "discrimination" it has caused could have been avoided.
It's getting really hard for me to understand what ASH is trying to do. They want smokers to be banned from employment. They want smokers not to be allowed to smoke anywhere but in the privacy of their own homes, and then only if they are not foster parents.
The only thing that makes sense to me in explaining what ASH is doing is that there is a huge amount of underlying hate of smokers, and that ASH apparently feels that smokers need to be punished for their "poor choices."
I challenge ASH to explain why they are not taking the lead in supporting legislation to deprive smokers of medical treatment. Such a move would save an incredible amount of money, would end the terrible discrimination that nonsmokers have to face by subsidizing health care costs for smokers, and would be a huge incentive for smokers to quit smoking and for nonsmokers not to start. It would be an incredibly effective public health intervention that would save lives and money. I don't see how ASH, by its very own reasoning, could possibly justify not supporting such a policy.
The logical endpoint of what ASH (and in the absence of any opposition - the anti-smoking movement) is actively promoting is the creation of second-class status for smokers. They are to become a group that is not capable of obtaining gainful employment and making a living to support themselves and their families.
And you know what? In the long-run, this would only serve to increase socioeconomic disparities in health and to increase smoking. But even if it didn't, it's just plain wrong.
The rest of the story is that a prominent anti-smoking group is actively promoting discrimination against smokers in the workplace, urging cities and employers across the nation to fire existing smoking employees and not to hire any smokers in the future. And the rest of the U.S. anti-smoking groups are sitting around quietly watching this happen.
Even if a single other anti-smoking group in the U.S. condemned these policies, I think it would pretty much bring an end to this nonsense. But most importantly, it would put employers and policy makers on notice that while creating smoke-free workplaces is an important public health goal, creating smoker-free workplaces is unjustified, intrusive, discriminatory, and improper.
According to the press release, entitled "Melbourne May Ban Off-the-Job Smoking by Employees; ASH Urges City to Act to Save 25% or More in Smoking-Related Costs," a workplace smoker ban is effective and appropriate because it would save money for the city as well as end "discrimination" against "the overwhelming majority of workers who have wisely chosen not to smoke by forcing them to assume -- directly or indirectly -- the costs of smoking."
The Rest of the Story
I consider February 9, 2006 to be an important date in tobacco control history. It marks the date that the anti-smoking movement officially went on record as supporting bans on smokers in the workplace.
My previous post, in which I suggested that ASH was encouraging employers to fire smokers, was met with some skepticism about whether ASH was actively encouraging such policies or merely trying to educate the public about the legality of doing so. It is now eminently clear that ASH was, and is, actively promoting such policies, and going so far as to intervene in the public policy deliberations of employers: in this case, the city of Melbourne.
While ASH is the only anti-smoking group that is actively promoting these policies, I am aware of no U.S. anti-smoking group that has publicly opposed these policies. Thus, as far as I'm concerned, the anti-smoking movement in the U.S. is officially on record as supporting these policies.
Those who are familiar with my commentaries know that I support workplace smoking bans. But I do not support workplace smoker bans. And there is a huge difference.
The ultimate irony is that ASH calls the fact that nonsmokers may bear increased health care costs because of smokers "discrimination," yet fails to appreciate that the policy it is proposing is actually a form of institutionalized employment discrimination.
Frankly, it is not discrimination (and it is an insult to the term discrimination) to use that term to describe the increased burden of health care costs that fall on nonsmokers. One could just as easily argue that thin people are discriminated against because they bear the costs of treating illnesses among fat people, or that vegetarians are discriminated against because they subsidize the costs of treating people who eat high-fat diets, or that non-bungee-jumpers are discriminated against because they have to subsidize the health care costs of treating bungee jumping injuries.
But it is truly employment discrimination to refuse to consider applications from smokers simply because of the category to which they belong, rather than based on any individual qualifications for employment (which cannot possibly be considered if their applications are immediately thrown in the trash based solely on the fact that they admit smoking off-the-job).
In my workplace, it is indisputably true that the major source of increased health care costs are employees, like myself, who have young children. We are sicker more, especially during the winter, and my co-workers without young children are bearing the burden of our increased illness.
By ASH's reasoning, my co-workers without young children are being discriminated against, and I should be fired. And I guess I should have been fired 4 years ago, when my first child was born. Or maybe they should have asked if I planned to have children when I first applied, and thrown my application in the garbage right then and there. Then all these problems and the "discrimination" it has caused could have been avoided.
It's getting really hard for me to understand what ASH is trying to do. They want smokers to be banned from employment. They want smokers not to be allowed to smoke anywhere but in the privacy of their own homes, and then only if they are not foster parents.
The only thing that makes sense to me in explaining what ASH is doing is that there is a huge amount of underlying hate of smokers, and that ASH apparently feels that smokers need to be punished for their "poor choices."
I challenge ASH to explain why they are not taking the lead in supporting legislation to deprive smokers of medical treatment. Such a move would save an incredible amount of money, would end the terrible discrimination that nonsmokers have to face by subsidizing health care costs for smokers, and would be a huge incentive for smokers to quit smoking and for nonsmokers not to start. It would be an incredibly effective public health intervention that would save lives and money. I don't see how ASH, by its very own reasoning, could possibly justify not supporting such a policy.
The logical endpoint of what ASH (and in the absence of any opposition - the anti-smoking movement) is actively promoting is the creation of second-class status for smokers. They are to become a group that is not capable of obtaining gainful employment and making a living to support themselves and their families.
And you know what? In the long-run, this would only serve to increase socioeconomic disparities in health and to increase smoking. But even if it didn't, it's just plain wrong.
The rest of the story is that a prominent anti-smoking group is actively promoting discrimination against smokers in the workplace, urging cities and employers across the nation to fire existing smoking employees and not to hire any smokers in the future. And the rest of the U.S. anti-smoking groups are sitting around quietly watching this happen.
Even if a single other anti-smoking group in the U.S. condemned these policies, I think it would pretty much bring an end to this nonsense. But most importantly, it would put employers and policy makers on notice that while creating smoke-free workplaces is an important public health goal, creating smoker-free workplaces is unjustified, intrusive, discriminatory, and improper.
Subscribe to:
Posts (Atom)