Friday, June 30, 2006

Surgeon General Warns Americans to Stay Away from Smokers

According to an Associated Press report that was published or cited in a number of papers (including the St. Petersburg Times), the Surgeon General's advice to Americans is to "Stay Away from Smokers."

The St. Petersburg Times headline: "For your health, stay away from smokers."

The Southeast Missourian had it as: "Surgeon General: 'Stay away from smokers'."

The Kane County Chronicle headline was simply: "Stay away from smokers."

An Associated Press article appearing in the Chicago Tribune reported that the Surgeon General summed up the entire report with the advice that Americans should stay away from smokers: "Surgeon General sums up massive report with this advice: 'Stay away from smokers.'"

The Rest of the Story

I want to comment on two aspects of this story.

First, I don't think that "stay away from smokers" is the appropriate message to be giving the American public. 'Stay away from secondhand smoke', perhaps, or 'stay away from smokers who are smoking', but not 'stay away from smokers'.

The message as it was apparently delivered seems to me to ostracize and isolate smokers and make them social pariahs, who nobody should even be near. What a lonely life it would be for smokers if we actually heeded this advice. And what a lonely life for the spouses and other family members of smokers who could not go near them if they took this advice.

I think that we can give the Surgeon General the benefit of the doubt and assume that he misspoke and this is not what he really meant. We can assume that what he actually meant was that nonsmokers should stay away from people who are smoking - from secondhand smoke.

Nevertheless, the way in which the message did come across is really problematic to me. Do we really benefit from having headlines all across the country imploring people to keep away from smokers? Does this not tend to stigmatize smokers and cast them as social pariahs and outcasts who are not even worthy of human contact and companionship? Does it not emphasize that the problem is one of a bad lifestyle choice rather than an environmental and occupational health issue? Does it not de-value the lives of smokers?

I'm sure that it wasn't intended to come out this way, but it did and we have to deal with the consequences of this being the primary message that "sums up" the entire report.

Do you mean to tell me that the message that is being carried to the public as summing up the entire report is that smokers should really be social outcasts that no one should go near? Again, I'm not saying that was the intent, but it appears it was the effect.

I think that's a shame, because there are a lot more appropriate and important messages that could and should come from the report than that one.

Second, this primary message of the communications about the findings of the report seems, at least in my eyes, to contradict the very title of the report: "The Health Consequences of Involuntary Exposure to Tobacco Smoke." If secondhand smoke exposure is involuntary, then people do not have a choice about avoiding it. If people are able to heed the Surgeon General's advice about staying away from smokers, then is it not true that their secondhand smoke exposure is not involuntary at all?

It occurs to me that you can't have it both ways. You can't propose as a solution to the problem that people stay away from smokers and at the same time try to convince us that exposure to secondhand smoke is involuntary. If people can avoid it by staying away from smokers, then is it not voluntary? If simply avoiding the smoke is the appropriate solution, then isn't the problem actually one of voluntary exposure to secondhand smoke?

The materials accompanying the Surgeon General's report are laced with advice to the public to avoid exposure to secondhand smoke. The brochure that accompanies the report instructs people how to protect themselves from the hazard discussed in the 727-page report. And the advice given is: "do not breathe secondhand smoke." "Visit smoke-free restaurants and public places." "Ask people not to smoke around you and your children." "Do not allow anyone to smoke near your child." "Use a smoke-free day care center." "Do not take your child to restaurants or other indoor public places that allow smoking." "Teach older kids to stay away from secondhand smoke." "Choose restaurants and bars that are smoke-free." "Be very careful not to go where [you] will be around secondhand smoke."

If this is the appropriate solution to what is cast as being a devastating public health problem, then isn't the title of the report misleading? Doesn't this advice cast secondhand smoke exposure as being largely voluntary? If you can choose to avoid it, then you're not involuntarily exposed.

My point here is that, once again, the communications surrounding the report are inconsistent with the report itself. If the solution we are proposing to the public is that they should "stay away from smokers," then isn't the problem one of voluntary exposure, and what we're trying to do is to shift the decision that people are making from one of being around smoke to one of avoiding smoke? Then why title the report "involuntary exposure to tobacco smoke?"

I'm not arguing here either that secondhand smoke exposure is truly voluntary or that telling people to avoid secondhand smoke is inappropriate. I'm simply pointing out the inconsistency of the communication to the public in light of the title and findings of the Surgeon General's report.

Frankly, if secondhand smoke is as bad as the Surgeon General tells us (even a brief exposure causes heart disease and lung cancer, everyone is at risk, there is no safe level of exposure, even drifting smoke outdoors is a major problem, even smoke coming out of a building through the doorway is a serious concern), then I would view it as irresponsible for the leading health officer of the nation to do anything other than recommend that smoking be banned completely.

How can you get up in front of the American people and try to convince them that secondhand smoke is so toxic and so carcinogenic that even a brief exposure is enough to cause fatal heart attacks and lung cancer, and then instruct them that the appropriate solution is simply: "don't breathe secondhand smoke?" And how can you argue that the appropriate solution is to simply choose to avoid secondhand smoke exposure if the problem you are talking about is involuntary?

To be honest, it seems to me that any toxic substance that is capable of causing lung cancer and heart disease from just a brief exposure should be banned - no questions asked. To take any other action seems irresponsible.

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