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Friday Interview: Smoking Ban Not Justified By Social Cost

Duke professor emeritus punctures myths about cigarettes' dangers

North Carolina will take new steps to restrict smoking in bars and restaurants, once Gov. Beverly Perdue signs House Bill 2. The House and Senate approved the bill this week. Supporters said the new restrictions would protect people’s health. John Staddon, James B. Duke professor of psychological and brain sciences and professor of biology and neurobiology emeritus at Duke University, doesn’t buy the argument. He recently discussed smoking restrictions with Mitch Kokai for Carolina Journal Radio. (Click here to find a station near you or to learn about the weekly CJ Radio podcast.)

Kokai: This is an issue we’ve all heard — smoking is bad for you, smoking is bad for you. And so the corollary to many people is [that] the government should take steps to reduce smoking or stamp it out. But you suggest that if we’re really interested about the societal effects of smoking, the government taking steps to reduce smoking doesn’t necessarily make sense.

Staddon: Well, yes. I mean the issue is, is smoking a public health problem? If you have something like an infectious disease — flu or something of this sort — clearly, the government has an interest in suppressing it and coming up with a flu vaccine, vaccinating as many people as possible, and so on. But if you have a health problem that affects only the individual involved and doesn’t significantly diminish that individual’s contribution to society, both of which are true of smoking, then it seems to me the social-cost argument for suppressing smoking, or attempting to suppress it, is weakened to the point that it doesn’t — it shouldn’t happen.

Kokai: Most people would accept that smoking causes harm to the smoker. You took issue … with people who suggest that smoking harms other people who are around the smoker.

Staddon: Well, there are two ways — perhaps three, let’s say three ways — in which something like smoking could harm others. It could change the behavior of the smoker, the way alcohol can change the behavior of a driver, to make him or her dangerous. Well, smoking doesn’t do that. Clearly, it has no effect of that sort. The second way that it could affect others is that the smoke itself — passive smoke — is dangerous. Turns out, the evidence for that is weak to zero. If you look carefully at the studies, they’re not statistically significant, and they’ve been thrown out by the courts.

And finally, the third way in which you can harm other people is via the social cost. That is, if society as a whole contributes to medical payments through Medicare or the state health service as they have in England — if smokers cost more in that department than nonsmokers — then we’re all paying for their particular vice. The main point of my talk was that, in fact, several careful studies have shown that far from increasing, having increased health-care costs, because smokers do die a little bit younger than nonsmokers — about eight years, seven … eight years — because they die younger than nonsmokers, the medical costs that they incur are actually quite a bit less — 30 or 40 percent less than the so-called healthy-living cohort. So in other words, smoking does not cost the rest of us. Of course, it costs the smoker. There’s no question about it; smoking is bad for you. I would recommend against it. But, from a societal point of view, it does not incur a cost.

Kokai: Some people are going to say, “Now wait a minute. You just said that people who smoke die earlier, and so we should not worry about their health. That’s the exact reason that we should worry about their health and that the government should step in.” Does this expose some of the problems with looking at smoking as a social-health issue — that if you’re really looking at it as a social-health issue, you should be encouraging smoking?

Staddon: Well, this is a good point. If that were the only variable, if the only thing that mattered were the total cost to society of any particular habit or so, yeah, then that’s right. Obviously, we should feel compassion for smokers to the extent that they feel compassion for themselves. In other words, if a smoker is happy to smoke, wants to smoke, then it seems to me we have no other interest in deterring him or her from smoking. On the other hand, if they want to give up, well, then just common humanitarianism suggests we should try and help them to give up. But it’s not — that’s sheer altruism — it’s not something that’s required by the cost that the smoker imposes on the rest of us.

Kokai: Do we create problems for ourselves, as a society, when we look at smoking or any other activity that people in government decide is a problem, and decide we should take steps to stamp it out?

Staddon: Well, yes. I think you have to be very clear on the reasons that you’re doing it. And for many, many years, the ostensible reason for attempting to stamp out smoking was that there was a collective cost to society. But that’s actually not true. So then we have to find some other basis, and the only other basis that there could be, presumably, would be aesthetics. You just don’t like the smell of smoke. The government could take care of that by requiring that a certain percentage of public facilities be smoke-free. I think most people would see that as perfectly reasonable. Or the other way, the other justification, is simply moral. This is bad. It’s just immoral to smoke. And, indeed, a lot of people now feel that. I don’t happen to feel that, and if you don’t agree with people who do, then you should be against regulating a habit that’s dangerous only to those who practice it.

Kokai: How many of the people who are pushing for a stamping out of smoking do you think understand these numbers? How many of them don’t care about the numbers — they just want a big nanny state?

Staddon: Well, I mean, a lot of people feel that it’s heartless to make the argument that I did, and they feel, well, if smoking is bad for these people, they should be discouraged from smoking. But then my response is, what right do you have to tell adults how they should behave? It doesn’t affect you. And I think if you believe that sort of libertarian position, then you will not want to regulate smoking. After all, you know, I don’t like velvet painting. I think it’s a terribly sort of crass activity, but I wouldn’t want the government to forbid it. There are a lot of things I don’t like, and you don’t like, that don’t have any collective effect on the rest of us, so there’s no basis for us to prevent it. But smoking has been successfully stigmatized, I think, to the point that people feel really good about suppressing smokers, trying to stamp out smoking, and so on. And I’m trying to get them to feel a little less good about it.

Kokai: Do you think this argument will eventually catch on — that people will decide that, wait a minute, we really aren’t looking at the proper issue when we’re deciding whether we should regulate smoking or not?

Staddon: Well, I hope people will begin to think or to look for the justification for coercive government action. And my feeling would be, unless someone can make a very good argument to the contrary, you should not prohibit something unless there’s a pretty good, either basic moral argument or an argument in terms of the collective good against it. In other words, you shouldn’t prohibit something unless it’s bad for everybody else or it’s simply intrinsically bad. And there are things like abortion, for example, which many people, perhaps most people, regard as intrinsically wrong. So, even though it has no effect on the rest of us, nevertheless there are laws in many places that limit abortion in certain ways and so on. But I don’t think smoking falls into that category.

Kokai: So, if someone is smoking right now, they should enjoy it?

Staddon: Yeah, it’s terrible for you, but if you’re happy, go for it.