Monday, May 22, 2006

Boston Herald Op-Ed Cautions that Anti-Smoking Movement is Going Too Far

My op-ed published in the Boston Herald on Saturday suggests that the anti-smoking movement has lost its reliance on an evidence-based approach and is turning into a crusade that is divorced from public health. In the article, I cite two trends to demonstrate this.

First is the recent support of anti-smoking groups for bans on smoking almost everywhere outdoors, such as in Calabasas, where smoking was banned on all streets, sidewalks, and parking lots or any other outdoors location where a nonsmoker is present, with the exception of private residences (and shopping malls).

As I point out, these policies are not supported by scientific evidence that outdoor exposure to secondhand smoke in places like sidewalks and parking lots, where nonsmokers can avoid the smoke, is causing a substantial public health problem. Instead, anti-smoking groups have been forced to rely on alternate justifications, such as trying to prevent kids from seeing smokers in public. This is social engineering at its worst: it treats smokers as social pariahs and as moral affronts, demonstrates intolerance, and takes tobacco control out of the realm of public health, turning it instead into a non-evidence-based moral crusade.

The second disturbing trend I cite is the spread of policies that fire smoking employees or which refuse to hire smokers. I argue that these policies represent discrimination against smokers, are unduly intrusive into private, lawful behavior in the home, and treat smokers as second-class citizens who are not worthy of employment in our society.

Some excerpts from the piece:

"As a physician who has devoted 21 years to advocacy in tobacco control, conducting research and publishing a number of studies on the hazards of secondhand smoke, it is not surprising that I favor a wide range of anti-smoking measures. But anti-smoking tactics adopted by some municipalities, companies and organizations do not serve smokers or the public. The methods are mean-spirited, unsupported by science and attempt to stamp out smoking by punishing and marginalizing smokers. They go too far. ...

The hazards of exposure to smoking in the workplace have been proven, but there is no scientific evidence that shows that small, transient exposures to secondhand smoke in outdoor areas - places where people can easily avoid prolonged exposure - represent any serious public health problem.

The argument that these policies are needed to prevent children from seeing people smoke in public would ostracize citizens for pursuing a legal activity. What comes next? Laws that ban fat people from the public square so that children won'’t associate obesity with public acceptability? Laws that prohibit people from eating fast food in public so children won'’t see this behavior and associate it with a healthy lifestyle? ...

Michigan-based Weyco Inc., announced a policy of denying employment to smokers last year, and it has been followed by the World Health Organization, Scotts Miracle-Gro, Crown Laboratories, the city of Melbourne, Fla., and Truman Medical Centers in Kansas City, Mo. ASH, along with these employers, argues that these policies are appropriate because they will reduce the increased health care costs associated with smoking. But what they also do is make smokers second-class citizens, depriving them of the right to make a living to support themselves and their families.

Is ASH serious? Should smokers not be allowed to hold jobs? Does it somehow promote public health to make the families of smokers go hungry? Should our society have two distinct classes, one that can work and another which cannot, simply because of a lawful, off-the-job behavior?

An appropriate public health policy for work-site health promotion would provide smoking employees with smoking-cessation programs, not fire them.

I fear that the anti-smoking movement is on the verge of running amok. Ultimately, what is at stake is the credibility of the tobacco-control movement, as well as the integrity of its evidence-based approach to the protection of the public'’s health. If we lose that, then the truly legitimate, science-based aspects of tobacco control will be undermined. And then it will become difficult, if not impossible, to advance any policies to protect the public from the hazards of tobacco."

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