tobacco fumage in a free society

One of the costs of living in a free society is that tobacco control is an issue that (at least I think) should be given some press. Two quotes by John Locke (the actual, historical, enlightenment era thinker, as opposed to the dude from “Lost”) illustrate the necessary tension in the matter:

"Every man has a property in his own person. This nobody has a right to, but himself."

"All mankind... being all equal and independent, no one ought to harm another in his life, health, liberty or possessions."

Any action taken by a government in order to make it more difficult for its people to smoke is always an infringement upon the first principle. However, any action *not* taken to reduce the well-documented hazards of second-hand smoke is an infringement upon the second (shouldn’t part of being free mean freedom from being poisoned?) Therefore, one of the few things that can be conclusively deduced is that there is no perfect solution to the smoking problem as long as there are people that want to smoke.

Clearly the first question we should ask about tobacco control in general is, “what is the ultimate point?” At the end of the day, we absolutely shouldn't care that people smoke or use tobacco products. We just don't want to see the ensuing morbidity and we don’t want to pay for anything. So something to remember is that we are, at the very core of our effort, only trying to curb the harmful effects of tobacco use, and if there was some way to sever the causal link between its use and the development of illness, then we no longer need be concerned about whether or not tobacco was being consumed.

After this question, different approaches to tobacco control will no longer stack up equally when viewed ethically. The three general types of control methods that I can think of are educating people about the consequences of smoking, legislation making it more difficult to smoke, and technologies to make smoking less harmful.

Education and legislation have had more success in the past, and have less potential for success in the future than a technological solution. Hear me out: from the middle of the 20th century, prevalence of tobacco use has declined among the US population, largely due to the education of the public about the associated risks of tobacco use. Among a certain segment of the population, education is *very* effective. This segment, of course, is the proportion of people that are willing to learn. On the other end of the spectrum are people that are apathetic toward whatever the "facts" might say, and these people are completely out of reach of any awareness program ever (or yet to be) invented. Legislation has undoubtedly played a part in the nationwide decline as well. It is effective as long as people obey the law, and more effective when multiple people are held to account (for example, it is unlawful for SA to sell a 12-year old kid cigarettes, and both the attendant and the kid have to break the law in order for a minor to buy tobacco). However, programs like increasing the tax on cigarettes and limiting locations where smoking is allowed, while making tobacco consumption more inconvenient do not really affect the smoking rates in the population. Legislation will *never* be able to achieve a high degree effectiveness, because the citizens it is meant to protect must willfully subject themselves to it or have it enforced under some kind of penalty. Technology has not offered as much in reducing the morbidity, although treatments for emphysemas and smoking-related cancers would probably fall under the technological solutions umbrella. However, as far as effectiveness goes, technological solutions do not have the same kind of limits set on them by human nature that education and legislation have. So, perhaps in the future the ethical balance will begin to tip this direction- as people begin to realize that interventions of any kind are unethical if their probability of success is nil. Unfortunately, right now, if I'm not mistaken, a public health program of this type would have the least empirical support for why it should be implemented.

Legislation is, by nature, an infringement on liberty. Really, it does not take choice away from people, so much as it simply makes certain options less appealing by associating them with various penalties. These all have to be enforced and thus further reduce liberties of those they are leveed against, as well as the greater society that finances this effort (through freedom of spending, etc.). Technological solutions are burdensome in that they take a lot of time, money and work to develop, and often they create new social and ethical issues of their own. Education is probably the least burdensome of the three, although mandatory education is, I suppose, a type of encroach upon freedom as well (although arguably not as severe as the kind legislation causes).

But also, a primary hurdle for an ethical intervention to clear is that of fair implementation. The major obstacle for all three of type of interventions that I suggested is SES, which is negatively associated with tobacco use. Things like the cigarette tax will hit the poor in society the hardest. One thing we know for sure is that making poor people poorer will *not* make them more likely to stop smoking; however, being poorer will significantly decrease their chances of being able to utilize technological solutions and being educated away from not using tobacco. The SES gradient ensures that any kind of punishment that we can attach to smoking will be more easily avoided by the well-to-do who break the same laws as the poor. Again, I think education would probably be more fairly applied than technological or legislative approaches due to the availability of the public school system.

Wow, I wrote a lot about this; I'm going to call myself done for now. But, in conclusion I am going to say that legislation is wholly undesirable compared to educational and technological approaches to tobacco control. Education would be the perfect solution in a perfect world, in which people were rational and made well-informed decisions based on data and long-term gain. Innovations in the physics of tobacco use and its consequences could one day be the most effective way to deal with the tobacco problem, but right now we're still waiting for said innovations to come along while hundreds of people die every day...

I don't know. Period.