Where There's Smoke There's Death

Stephen H. Unger
Oct. 19, 2016

Altho smoking is becoming less popular in the US, cigarette smoking accounts for nearly one out of every 5 American deaths: about 480,000 annually [1]. Roughly 45,000 of those killed were not even smokers--they were victims of secondhand smoke. The number of victims of secondhand smoke is about equal to the sum of the number of people killed annually in automobile accidents plus the number killed annually in gun homicides. But, while there is much heated discussion in the various media about the need to do more to prevent gun homicides (there are about 11,000 annually [2]), we seldom see newspaper or magazine articles or editorials, or TV programs, that discuss how we might address the smoking problem, the cause of forty times as many deaths.

There are many mechanisms for smoking deaths, with lung cancer, and heart disease leading the list. Cigarette smoke contains over 4,000 chemicals, including over 50 known causes of cancer (carcinogens), as well as other poisons. In addition to killing people, smoking causes, or aggravates, a wide variety of debilitating illnesses: e.g., heart disease, emphysema, and dementia. More than 16 million American smokers (or ex-smokers) live with such diseases. The annual cost in the US of tobacco-related medical treatment, plus the annual cost of lost work-time due to tobacco-related lost work-time exceeds $300 billion [3].

Worldwide, it is estimated that almost 6 million people die annually as a result of smoking [4]. While Americans now smoke less than in the past, the Chinese have been smoking more (most Chinese men smoke), and the number continues to grow. Altho relatively few Chinese women currently smoke (about 2%), over a million Chinese die annually from this cause, and it is projected that by 2050 the number will triple [5]. The Chinese government owns and operates the world's largest tobacco company, which produces roughly 90% of the cigarettes consumed in China.

At present, over 40 million American adults (about 16% of the adult population) smoke cigarettes. The percentage of Americans who smoke decreases as education levels increase, varying from 26% for those who never finished high school, to 5% for those with postgraduate degrees [6].

Some other destructive products

While tobacco is, by far, the most harmful consumer product in wide use, there are, of course, other substances that, to varying degrees, are also harmful. Alcohol is the strongest competitor, accounting for about 88,000 US deaths annually [7]. Just as smoking harms nonsmokers via secondhand smoke, alcohol harms nondrinkers via drunk drivers. An important difference between tobacco and alcohol is that, whereas regular smoking, even at low levels, is harmful to health, moderate drinking (one or two drinks per day), is generally not harmful--and for many may actually reduce the likelihood of certain diseases.

Yet another complicating factor is the effect of timing of drinking. There are significant differences between the effects of 7 drinks per week spread evenly over 7 days, and all 7 taken during a 2-hour period on one day of the week (binge drinking).

As is the case for tobacco, people vary greatly in their responses to alcohol. For both substances, there are exceptional people who are far less sensitive to the harmful effects.

Addictive drugs, such as heroin, have been illegal since early in the twentieth century [8]. About 300,000 people are in state or federal prisons (2013-14) for selling, buying, or possessing such drugs. Unlike tobacco, many of these illegal drugs have some useful medical applications.

Drug overdose deaths, from legal and illegal drugs, in the US reached 47,055 in 2014 [9]. Isn't it interesting that it is illegal to buy or sell such substances (except for prescription drugs) [10], whereas it is legal to buy or sell tobacco products, that kill ten times as many people? I see no basic difference between tobacco and, for example, heroin. Both are addictive, debilitating, and deadly.

What is being done about this?

Thus far, the most useful steps addressing the smoking problem in the US are the high sales taxes (federal, state, and local) on tobacco products, and restrictions on tobacco advertisements. Other measures include prohibiting sale of tobacco products to minors, and a federal requirement that anti-smoking messages be on cigarette packages. There are some other federal restrictions such as prohibiting smoking on airliners. In most states there are state or local laws prohibiting smoking under various circumstances, e.g., in restaurants or movie theaters [11]. These measures have undoubtedly played a role in reducing the number of American smokers. But that number is still huge. The tobacco industry remains very profitable [12].

Why is it still legal to sell a product that is killing huge numbers of people?

It makes no sense to allow the production and sale of a product that causes people to acquire a habit that is exceedingly harmful and dangerous, as well as very difficult to break. In addition to those killed by tobacco, there are many more smokers who suffer from painful and/or disabling illnesses. Most members of the community of tobacco addicts, many of whom joined as teenagers, wish they could escape. A Gallup Poll [13], indicated that almost 90% of smokers regret that they ever started smoking.

In 1938, medical researchers at Johns Hopkins University published articles in scientific journals, based on extensive research, that clearly established the deadly nature of smoking. There were only a very few articles about this work in the mass media. From 1941 to 1950, the maverick journalist, George Seldes, reported extensively on the implications of this research in his newsletter, In Fact [14]. It was only in the mid 1960s that the mainstream news media broke the news to the general public. Since that time, the great harmfulness of tobacco has been accepted by virtually all scientists in the relevant disciplines who are not on the payroll of the tobacco companies.

Given the marked resemblance of the effects of tobacco smoking on people to the effects of heroin use: addiction, a variety of illnesses, and, all too often, death, why is tobacco still a legal product? The obvious answer is that growing tobacco, using it to produce cigarettes, cigars, etc., and selling these products is very profitable. Annual profits of the big US tobacco companies total many billions of dollars. (I could not find a good, up-to-date, source with precise numbers). An unfortunate side effect of the high taxes on these products is that some state and local governments are reluctant to outlaw or discourage smoking, from which they derive significant revenue. Tobacco companies spend a lot of money to influence government at all levels, and to propagandize the public.

In 1998, The Tobacco Master Settlement Agreement [15] was signed by the 4 largest American tobacco companies, and a consortium of 46 states and several territories (the other 4 states had signed an earlier settlement). This required the companies to pay the states a minimum of $206 billion over the first 25 years of the agreement in partial compensation for health care costs associated with smoking. The agreement also called for termination or curtailing of various marketing practices, and funded an anti-smoking advocacy group. In return, various law suits against the companies were terminated, and the companies were exempted from private tort liability suits. This agreement did not cause a dramatic drop in the number of smokers, which had been falling since 1965, but which is still very large.

What else should be done?

First, what should not be done? I would oppose a general law prohibiting adults from smoking, other than, as at present, prohibiting smoking in various situations that would expose other people to tobacco smoke. (Similarly, I oppose existing laws that are sending people to prison for purchasing or using narcotics.) Users of tobacco, or other harmful substances, are victims, not criminals.

I advocate outlawing the production for sale, and the sale, of tobacco in all forms (with carefully specified exceptions for small amounts produced for research purposes.) The penalties should be very substantial. A person who grows tobacco and processes it for personal use, in ways that do not endanger others, might be considered as reckless, but should not be treated as a criminal.

It is hard to see how anybody seriously involved in the production or sale of tobacco products today could be ignorant of their pernicious nature. Obviously, we cannot pass ex post facto laws to punish such people for their behavior while tobacco was a legal product (this can be, and has, to a limited extent, already been done, to a modest extent, via civil law suits), but, once tobacco is legally outlawed, penalties for subsequent violations should be severe. Long prison sentences should be mandatory for the industry higher ups. Tobacco industry corporations that attempt to continue operating as such should be subjected to fines large enough to put them out of business, and the responsible corporate officers should be jailed. Stockholders in those companies deserve no sympathy if they suffer large losses, as they too were complicit in a terrible, ongoing, crime.

Our sympathy should be reserved for the victims of this crime, the tens of millions lured into becoming smokers, and the families of smokers. The most difficult problem will be that of easing the withdrawal pains that will be experienced by those smokers who are strongly addicted. It may be necessary to allow for a gradual withdrawal in some cases--perhaps under medical supervision. Research and development to devise ways to facilitate this process should be publicly funded. It would be appropriate to allocate substantial public funds to establish and operate treatment centers to help smokers kick the habit.

It is easy to say that the tobacco industry should be shut down, and to specify various measures. as above, to accomplish this. But getting the appropriate laws passed and enforced will be extremely difficult. Since its inception, this lucrative industry has successfully defended itself by employing top notch legal talent, at great cost [16], by giving money to members of congress, and to other politicians [17], and by advertising (thereby gaining the implicit support from the media--mainly in the form of silence) [18]. The fact that there are large tobacco companies outside the US, makes it likely that there would be smuggling, and black market sales, of tobacco products. In this respect, it would be very helpful if the phase-out of smoking was an international effort.

This essay is about cigarettes, and peripherally about tobacco. Alternatives such as cigars, water pipes, and electronic cigarettes have not been studied as much as conventional cigarettes, but all indications are that they are not significantly less harmful than conventional cigarettes [19].

Most Americans can think of relatives, or friends, or associates, who were killed or disabled by tobacco. This is an area in which people with diverse political views should be able to join forces to begin the difficult task of shutting down this pernicious industry.


[1] Office on Smoking and Health, "Tobacco-Related Mortality", National Center for Chronic Disease Prevention and Health Promotion, August 18, 2015

[2] Kenneth D. Kochanek, Sherry L. Murphy, Jiaquan Xu, Betzaida Tejada-Vera, "Deaths: Final Data for 2014", National Vital Statistics Reports, June 30, 2016

[3] Centers for Disease Control and Prevention, "Smoking & Tobacco Use: Fast Facts", CDC, December 11, 2015

[4] Nicolas Rapp, Ryan Bradley, "Tobacco trade around the world", Fortune Magazine, November 21, 2013

[5] Madison Park, "China, world's leading tobacco user, moves to ban indoor public smoking", CNN, January 9, 2014

[6] Drew Desilver, "Who smokes in America?", Pew Research Center, February 7, 2014

[7] NIH, "Alcohol Facts and Statistics", National Institutes of Health, Revised June 2016

[8] , "Illegal Drugs in America: A Modern History"

[9] Haeyoun Park, Matthew Bloch, "How the Epidemic of Drug Overdose Deaths Ripples Across America", NY Times, Jan. 19, 2016

[10] DrugWarFacts.org, "Prisons, Jails, and People Arrested for Drugs"

[11] HHS.gov, "BeTobaccoFree.gov", U.S. Department of Health & Human Services, September 27, 2016

[12] Centers for Disease Control and Prevention, "Economic Facts About U.S. Tobacco Production and Use", July 18, 2016

[13] Alyssa Brown, "In U.S., Smokers Light Up Less Than Ever", Gallup, September 13, 2012

[14] George Seldes, "George Seldes on Tobacco: Fifty Years Ahead of His Time More than 50 articles from Seldes's newsletter In fact (1940-1950)"

[15] Wikipedia, "Tobacco Master Settlement Agreement"

[16] Myron Levin, "Smoking's Big Guns", Los Angeles Times, December 15, 1996

[17] Action on Smoking and Health (ASH), "Big Tobacco Buys Big Political Influence: Money is doled out to both sides of the aisle", October 16, 2012

[18] Noel Young, "US cigarette giant starts advertising again in magazines with millions of young readers", The Drum, June 2013

[19] Andrea Korte, "Alternative Tobacco Products May Be Just As Dangerous As Cigarettes", Press briefing at the 2016 AAAS Annual Meeting, February 12, 2016

Comments are welcomed and can be sent to me at unger(at)cs(dot)columbia(dot)edu

Don't forget to replace (at) with @ and (dot) with the symbol .

Return to Ends and Means to see other articles that you might find interesting.