Tuesday, February 19, 2008

Licensed to Smoke: ASH Supports Proposal to Require License to Purchase Tobacco Products

According to a press release issued by Action on Smoking and Health (ASH), the group is supporting a proposal that would require smokers in the UK to obtain a license in order to purchase tobacco products. ASH is not only supporting the proposal, but is actually working to strengthen it by increasing the requirements that must be met in order to obtain a license to smoke.

First, ASH wants, as a condition of obtaining a license to smoke, that applicants read and sign a document indicating that they understand all the health effects of secondhand smoke. Notably, that information would include the "fact" that "exposure for as little as thirty minutes can trigger a fatal heart attack in adults."

Second, ASH wants, as an additional condition of obtaining a license to smoke, that applicants "thoroughly understand all of the health and financial consequences to themselves of continuing to smoke, and that they are willing to accept these risks and burdens."

Third, ASH wants applicants to be "required to review information about various cessation techniques and cessation programs (especially those available in their area), including various forms of pharmacological intervention."

Fourth, ASH wants applicants to be "required to provide a form signed by a physician or other appropriate health professional certifying that whatever tests are appropriate for someone with the heightened health risks caused by smoking (e.g., a chest X-ray every 5 years after the age of 40, etc.) had been performed, and the smoker had been advised of the results of the tests."

The Rest of the Story

I think this is a splendid proposal.

But since it is such a great idea, I think we ought to extend it to other health behaviors as well.

So first, I would like to propose that anyone wishing to drink alcohol must obtain a license in order to purchase alcohol. Before obtaining such a license, the applicant should be required to articulate the health effects of alcohol, including its effects on liver function, brain cells, cancer risk, and the gastrointestinal mucosa. The person must also sign a statement indicating that he understands all the risks and financial consequences of drinking, and is affirmatively choosing to take such risks. I think the person should be required to submit a signed affadavit, notarized by a public notary, that no other person is coercing or otherwise exerting undue influence on that person's decision to drink alcohol. I believe the person should also be required to have liver function tests to make sure that his or her liver isn't already shot, to have a liver scan to detect any potential carcinogenic lesions, and to have an upper endoscopy - both to rule out esophageal cancer and to screen for ulcers, which may be caused by or exacerbated by drinking.

Second, I would like to propose that anyone wishing to eat trans-fats should be required to obtain a license to purchase products containing trans-fats. All grocery stores could be equipped with technology that would quickly determine if any given product contains trans-fats. This information could easily be obtained from the product's bar code. If trans-fats are contained in a product, the grocery clerk would be alerted and would demand that the customer provide a trans-fat consumption license. To maintain such a license, the person would have to take a renewal test every five years, with questions on the latest epidemiologic data on the risks of trans-fat consumption.

Third, I would like to propose that anyone wishing to engage in sex be required to purchase a license. While many people would not do so, the law could be changed so that in the case of a person obtaining an STD, the failure of the partner to have obtained a license would be grounds for compensation of the victim by that individual. Applicants for these licenses would be given courses on HIV/AIDS, syphilis, human papillomavirus, and other agents known to be responsible for the sexual transmission of disease. They would also be required to undergo a physical examination and screening for current STD's. To protect privacy, any applicant could request a same-sex examiner and screener.

Despite the highly sensible approach being suggested by ASH, I do have a few concerns.

First, what if it is the case that only 5 minutes of secondhand smoke exposure causes heart attacks, as claimed by one anti-smoking group? Wouldn't telling people that it takes a whole 30 minutes then be deceptive? Wouldn't people take it too lightly?

Since one anti-smoking group has claimed that just 30 seconds of tobacco smoke exposure is as bad as a lifetime of active smoking in terms of impaired coronary artery function, I have the same problem with telling people that 5 minutes of secondhand smoke causes heart attacks. I think we'd have to get it down to at least 30 seconds, if not lower.

Second, people may claim to understand the financial consequences of smoking, but without really understanding financial accounting, can we really expect them to be able to predict the effect of their smoking on their future financial status? At a minimum, I think smokers should be required to complete a course on financial accounting before obtaining a license to smoke.

Third, since people are going to be made aware of various forms of pharmacologic treatment available to help smokers quit, I'm a little concerned that smoking license applicants might actually be informed about the suicide risks associated with Chantix, and might therefore might not be as receptive to it as they might otherwise be. I would like to see a clause in this legislation that excuses the licensing organization from revealing the full information about the risks of Chantix. The staff of the orgnanization should be provided with full legal immunity in the case someone takes Chantix as a result of their being informed of the available pharmacologic therapies and ends up committing suicide as a result.

Finally, since ASH is asking for required medical testing that has been clearly deemed inappropriate by every major medical body that has considered the issue (i.e., chest x-ray screeening every 5 years after age 40), I would like to add some ill-advised medical tests of my own. Why not simply require a whole-body CT scan? I see no reason to leave any body part untouched.

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