Hello everyone, and thank you for inviting me to participate in this discussion.  This forum, where ideas are expressed, issues debated and opinions formed, is a vital part of learning and I am happy to see many students present today. Whether you agree or disagree with either of the speakers, I encourage each of you to formulate your own opinions on this topic – and to become an advocate for your beliefs.

 

The question of whether or not government should restrict smoking in private businesses is one that will affect everyone in this room.  Restricting smoking limits the rights of some, in order to protect the health of others. 

 

While the delicate balance of personal liberties and government control are at stake, I believe this debate to be about preserving the public health.  And when Dr. Levy and I have debated our positions, it will still be true that an individual can only enjoy personal freedom of choice if they are healthy enough to do so.

 

To this point, we know that smoking is harmful to ones health.  There are literally thousands of published research papers and reports describing the risks associated with cigarettes and smoking.  This literature does not always provide an absolute answer to the questions at hand, but, it does provide us with a basis of knowledge from which responsible decisions can be made.  Good science requires us to examine this body of research, understanding that it is subject to the process, strengths and shortcomings of the scientific method, and the interpretation of investigators. 

 

In my opinion the literature clearly demonstrates that smoking is dangerous to smokers and non smokers alike, and is responsible for high levels of morbidity and mortality in the US and world wide.

 

While important, evaluating the science of smoking is not my goal today.  What we need to talk about are the issues central to smoking that impact individual choice, and public health.  These include:

·        the issue of addiction

·        lifestyle choices and

·        socioeconomic and political considerations.

 

These are the some of the factors that influence how people view smoking, and whether or not an individual will choose to smoke.

 

A nicotine addiction is a serious addiction.  The nature of a nicotine craving is not is not unlike cocaine or even heroin.  While smoking, the stimulant properties of nicotine are generally felt within seconds of inhalation, as the nicotine laced blood reaches the brain, and other vital organs.

 

Consider a smoker who smokes a pack a day, 20 cigarettes, with an average of 10 good puffs per cigarette.  This is the equivalent of 200 “hits” of nicotine daily.  This explains why people will go to such lengths to get their nicotine, and oppose any efforts to restrict their ability to smoke when and where they want.

 

Experts in smoking cessation as well as smokers agree that it’s just not that easy to quit smoking.  According to the US Public Health Service, an astounding 90%, or more of those who attempt to quit smoking on their own – fail. 

 

Just this week, a smokers intense craving for a cigarette was vividly demonstrated to me.  While leaving work on Monday, tropical storm Jeanne was making her presence know in Athens.  I walked through the parking lot and past the food services area behind Snelling Hall.  While struggling with my umbrella, I was surprised to see, in the midst of the wind and the rain, three people standing under a pecan tree, getting soaked, struggling to keep cigarettes lit under umbrella’s and a cardboard box.  Now, the cardboard box was the most interesting part of this scene because it was draped over one of individuals so that all I could see was the person’s legs, and the smoke drifting upward from the box. 

 

Make no mistake – the craving for nicotine is strong.

 

Smoking is also a lifestyle choice.  As Americans we are free to make our choices.  But, with freedom also comes responsibility.  The right to smoke should carry with it the responsibility not to harm others in doing so.   Second hand smoke is dangerous to those forced to breathe it.  While to me the evidence is clear, I recognize that there is debate over the magnitude of the risk posed to others by second hand smoke.  My position is that any level of second hand or environmental tobacco smoke that results in a health risk to others is unacceptable from a public health perspective.

 

When you read studies on cigarettes and smoking you will note that education level, income or other socioeconomic indicators are almost always present.  The reason for this is that poorer people smoke more than those in higher income groups.  In addition to posing a health threat to others via second hand smoke, some of these individuals, those in medical assistance programs such as Medicaid, will incur health care costs that taxpayers will have to pay for.  

 

Smokers who become ill need to be willing to take responsibility for their choices and recognize that it is not the tobacco company or anyone else that is at the root of their situation, but rather their choice to continue smoking even with the knowledge that smoking is dangerous to their health.

 

From the political perspective, government has attempted to create legislation controlling behavior before, such as the prohibition of alcohol.  This was largely a failure, and provides evidence that government intervention in personal decision making may not be a good idea.  While this isn’t good for my position, I should point out that unlike prohibition, ordinances limiting smoking are designed to limit smoking to when your second hand smoke can harm others.

 

Since bars and restaurants are public gathering places, and non smokers will be exposed to harmful second hand smoke, it is my opinion that the charge in the constitution to “promote the general welfare” gives us direction.   If individuals can not stop smoking, as in the case of addiction, or will not stop by virtue of their lifestyle choices, and these decisions harm others, or require others to pay for their poor choices, I believe the government has the duty to “promote the general welfare” and intervene. 

 

 

In making a decision to restrict or ban smoking legislators will have to balance the issues of:

 

  • Public and individual health
  • Legitimate industry/business rights to produce, promote and sell products
  • The duty, authority and responsibility of government
  • Individual rights, including those of smokers and non smokers, and
  • Societal responsibilities

 

How one views the importance of these competing ends will shape their position in this debate.  My perspective is to heavily weight public and individual health.  So the questions are, where do individuals’ rights begin and where does the government’s responsibility end, and who should make these decisions? 

 

Let’s consider some of the options.

 

Private business owners are going to be motivated to meet customer needs in the best way they can.  The issue of smoking for the small business enterprise is not a political or public health issue; it is an issue of survival.  It is not really about whether or not you can smoke in a particular establishment before or after a certain time.  It is a question of whether this business provides services customers will be willing to pay for.  If cigarette smoke is offensive to you, you will not patronize businesses with smoky environments, and business owners know this.

 

If there were evidence that revenues would soar if restaurants and bars were all smoke free, we would see voluntary restrictions by business owners. But, in local communities, customer bases may be perceived as insufficient to support a business without both the smoking and non smoking customers.  So, whose rights should prevail?  And what about the employees of the business who must breathe second hand smoke?  I believe they have the right to work in a safe environment.

 

What about corporate America?  I don’t think I want big business making decisions for me.  You see I went to New Providence High School, in New Providence New Jersey.  One of my class mates was Richard Fastow, the older brother of Andy Fastow – of Enron fame.  With this continuing current even in American corporate integrity, the sometimes questionable motives of the tobacco industry, and a healthy dose of skepticism, as decision variables, I think I can safely rule out corporate America as whom I want making decisions which could affect my health.

 

As for other individuals making choices for me, my belief is that there is little sympathy for the nonsmoker in a crowd of smokers.  Some would argue that if you don’t like the smoke, you can simply leave, go somewhere else, or just stay home. So again, whose rights are more important?

 

What about me?  Should I make my own decisions about what behaviors and lifestyle choices I engage in?  Yes, but, when my choices harm others do I maintain this right or do I have a greater responsibility to the general welfare?

 

For many of us, we are familiar with the harmful effects of smoking.  But this may not be true for everyone.  I understand the basic mechanism of action for the harmful effects of cigarette smoking.  It is oxidative stress which damages cells and causes illness.  I know that smoking:

 

·        Infuses toxins into my body that can damage virtually every organ system – traveling everywhere blood flows

·        Causes cancer, stroke, heart disease, and respiratory diseases

·        Smoking affects infants, children, adolescents, and adults

·        And, it places you and your baby at risk if you are pregnant.

 

But, do the 4000 teens that the Surgeon General estimates light up for the first time everyday know all this? 

 

Would they still choose to smoke in these numbers if they did – or – if opportunities to light up were increasingly limited?  This may be the best reason why we need government to step in and play a role in this public health issue.

 

GOVERNMENT

 

In today’s world there are threats to your safety that did not exist until recently.  The recent events of nine-eleven and the war on terrorism, preservation of our environment, global warming, strip mining and oil exploration, distracted driving, and the war on drug abuse are a few areas where individual action probably will NOT be effective in solving societal problems.  We will have to tolerate government intervention on issues such as these, including controlling second hand smoke, even at the expense of some individual rights.

 

CONCLUSION

This is a public health issue.  We must place the health and welfare of the public first in this debate, and in my opinion, ahead of the personal liberty to choose to smoke whenever and wherever a person wants.

 

I realize that governmental restrictions will not be able to solve all the problems associated with smoking.  These restrictions won’t be able to eliminate the health risks of smoking for smokers, but they will reduce the harm to non smokers breathing second hand smoke. 

 

And for some of the problems with smoking – governmental restrictions will have no effect.  Let me give you an example, 10 years ago while working at a community pharmacy in NE GA, I was filling a prescription for a narcotic pain reliever for a patient with a broken leg.  While talking with him about the effects of the medication, he related the story of how he came to break his leg.  You see he was driving a large dump truck and had just lit a cigarette which he dropped onto the floor of the truck.  He reached down for the cigarette, strayed into the oncoming lane and killed a couple driving in the opposite direction.  I tell you this story because I realize government can only go so far. While we can never hope to legislate a solution to this tragedy, we can support our local communities as they limit opportunities for smokers to harm others by their lifestyle choices.  

 

Smoking is bad for you.  If you don’t smoke, don’t start.  If you smoke, that is your choice.  If you smoke and are not aware of the facts related to smoking and health, you owe it to yourself to get educated. 

 

I believe it is the responsibility of every health professional to stand up for and defend smoke free environments.  This will take serious effort and will be met with opposition from the tobacco industry, smokers and those who believe, that more government can never be good.  What we need is for our society to evolve to the place where the harmful effects of smoking are recognized and there is no need for legislation to protect the general welfare.

 

REBUTTAL FACTS

  • Medline search, English only, from 1970 until Monday of this week.   84,775 articles on smoking where the issue was smoking, or smoking was a predictive/confounding/ controlling variable for some other measure.
  • Smoking and cancer 13,797 for the same period.
  • Environmental tobacco smoke, 1445 articles
  • Tobacco and cancer 5345
  • Secondhand smoke 132 articles

 

Why would we think second hand smoke would not be bad for you?  Filters do very little to the smoke.  They turn yellow – and so you your walls and curtains.  Smoke is what it is, a carcinogen.

 

And that it costs us more 75 billion in direct medical costs (that you and I  ultimately pay for through medical assistance programs and higher insurance premiums)  And results in 82 billion dollars worth of lost worker productivity

 

On the issue of research - If the methodologies are not sufficient, or well powered enough to provide an association, it does not mean one does not exist.  The method could be flawed, the sample size too small, too many confounding factors, or – the phenomenon may not exist – lots of choices, only one of which is what Levy proscribes.

 

Local laws on smoking seem to be the best approach to protect the public from exposure to second hand smoke. 

On the books right now….laws restricting smoking:

1540 local ordinances banning smoking to some degree

1124 restricting smoking in private workplaces

961 restricting smoking in restaurants

119 restricting smoking in freestanding bars  - why so few in bars?

 

 

“We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defense, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity do ordain and establish this Constitution for the United States of America.”