Thursday, February 28, 2013

Head of Smoking Cessation Treatment of UPenn Health System Speaks Out Against Smoker Discrimination Policy

The head of smoking cessation treatment for the University of Pennsylvania Health System - Dr. Frank Leone - has spoken out against the recently announced ban on the hiring of nicotine users, arguing that it may not actually decrease health care costs.

In an article published by Newsworks, Dr. Leone called the policy "regressive" and suggested that job applicants who smoke are likely to hide their cigarette use, making it subsequently impossible for them to join smoking cessation programs without risking job termination.

According to the article: "The head of the University of Pennsylvania's smoking treatment program said the health system's new policy not to hire smokers is a bad one. The clinics and hospitals within the system will no longer hire tobacco users starting July 1 of this year, according to a Penn Medicine careers website. It's an effort to improve employee health and cut down on healthcare costs. New hires will be required to self-report and will face disciplinary action, up to termination, if they are caught in a lie. Dr. Frank Leone, director of Penn's Comprehensive Smoking Treatment Program, doesn't think it will improve health or cut down on healthcare costs. "People have dealt with this for a very long time, desperately wanting to quit, unable to quit, confused about why they can't quit," Leone said of smokers. Then, in order to get a job they really need, he said they will have to say they don't smoke. "It's hard to imagine a person doing anything but really just hiding the fact that they're a smoker," Leone said. "And once that happens, particularly in a healthcare institution, the chances that they'll go and seek care for the problem go down considerably in my mind." Smokers in hiding will still be employed, but won't take advantage of employer-offered smoking cessation programs, and healthcare costs will not be impacted, Leone argued.

The Rest of the Story

Dr. Leone presents an intriguing argument. It is likely that many applicants who smoke will simply hide that private behavior from the employer. However, once hired, they will have to keep that behavior hidden because if exposed, it could cost them their jobs. Therefore, they are unlikely to take part in smoking cessation programs or other employer-offered incentive programs to help them quit smoking.

In the same article, Lewis Maltby, head of the National Workrights Institute, offers a compelling argument against UPenn's employment discrimination policy: "What you do in your own home on your own time, is none of your boss's business. Everything you do in your private life affects your healthcare costs. What you eat. Do you consume alcohol? How do you get around? Do you drive a car or ride a bicycle? And, heaven forbid, you should ride a motorcycle. If it's ok to tell people they can't smoke in their own home because it impacts company medical costs, there is nothing in your private life that isn't subject to employer control."

There is yet another argument against this policy which I didn't mention in yesterday's commentary. The policy applies not just to smokers but to all nicotine users. This means, presumably, that if a smoker is trying to quit smoking by using nicotine replacement therapy or electronic cigarettes, he or she is not eligible for employment. And if an ex-smoker has actually quit smoking successfully using NRT or electronic cigarettes, he too is ineligible for employment if he is continuing to use those replacement products.

This is ludicrous because it punishes smokers who are trying to quit. The policy, then, isn't about health but about an abstinence-only ideology.

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