Book review: Unlucky Strike - The Science, Law and Politics of Smoking
Monday, February 3, 2014 at 14:11 I first read this book when I was sent the manuscript, six months ago, by the author John Staddon.
I enjoyed it immensely. John is an academic at Duke University in the United States (and a visiting professor at York University) but it’s far from stuffy. In fact it’s an easy and entertaining read.
The author is sympathetic to the plight of smokers but he's not one-eyed on the subject. He accepts, for example, that smoking shortens the lives of many consumers.
Unlucky Strike was originally commissioned by a leading Washington think tank. When I read the manuscript I thought there might be too much focus on the US healthcare system and the Master Settlement Agreement to truly engage a British audience.
Perhaps it's been edited since then, or I'm imagining it, but that doesn't seem to be the case with the published book. In any case, most of the issues are generic and will be understood by readers on both sides of the Atlantic.
Staddon addresses a number of questions, some philosophical, others factual. What is the common good? How dangerous is smoking? What do smokers cost society? Do anti-smoking policies make sense in light of the facts?
The facts, he says, should make society far more relaxed about smoking than it is. For example, how dangerous are cigarettes, really? "Overall," he concludes, "the evidence is that smoking is risky but far from invariably lethal."
Likewise, and contrary to received wisdom, smoking does not put the public purse at risk because smokers pay in far more than they take out.
Staddon questions whether smoking is a public health problem and concludes that, actually, it's a private health problem so the state should butt out.
He also questions the value of longevity. Smoking, he says, shortens life but is that a reason for society to suppress it? Is extending life good for everybody? Old age, he suggests (and I agree), is not always a blessing.
These are not the rantings of a lunatic. Staddon asks serious, thought-provoking questions that a mature society should seek to answer.
The book also addresses addiction, the benefits of smoking and the alleged perils of environmental tobacco smoke (ETS).
"Is ETS really dangerous to children?" he asks before noting that the ill effects of passive smoking on children are highly significant politically. You can say that again!
The book is delightfully non-PC. "The war against smoking has become a secular religion ... For a common cause of death like heart attack, identifying smoking as the cause of any particular death – or even as a risk factor – is essentially impossible ... The bottom line is that even with maximal exposure to ETS, evidence for serious health effects of ETS is minimal to zero." And so on.
More controversially, perhaps, he compares government attitudes to smoking and Aids. "Most Aids sufferers are responsible for their own illness," he writes, "and governments have spent a fortune searching for a cure." In contrast, "government has not spent a nickel looking for a 'safe' cigarette".
When I read this passage in the original manuscript I felt a bit uncomfortable. Why bring Aids (and therefore homosexuality) into it? I still think it's a hostage to fortune because, taken out of context, it could be seized upon by detractors to distract attention from the rest of the book.
But Staddon has a point about the apparent lack of interest in developing a 'safe' cigarette. When it comes to smoking the message is 'quit or die'.
The question I would like to ask is this: why doesn't government commission research to find out why some smokers live to a ripe old age with little sign of ill health, while others are more susceptible to 'smoking-related' diseases?
It has always puzzled me that all the money goes into smoking cessation and nothing (as far as I know) into research concerning the Russian roulette aspect of smoking.
This abstinence-only policy, says Staddon, "has put a stop to research on making smoking safer", which, when you think about it, is a crime in itself.
Apart from being scornful of anti-smoking health activists who have "no problem with stigmatizing and being judgemental about smokers", Staddon's harshest words are directed at the Master Settlement Agreement:
The great scandal of the MSA is that the people who have to pay its huge costs – smokers – had no say at all in the in the agreement. The MSA is "tyranny of the majority" and "taxation without representation" on a scale that dwarfs the colonial imposts that prompted the Boston tea party.
The MSA, he adds, "did nothing for smokers, even failing to reduce their numbers below historical trends".
Even more damningly, he writes:
Questionable science, flawed law, massaged emotion and malign incentives have combined to warp public policy in ways that punish smokers but yield little public gain.
Searching for an explanation for today's anti-smoking orthodoxy, Staddon concludes, "It seems that human beings need to despise somebody."
If that sounds thoroughly depressing, the book itself isn't. Personally it gave me a lift to know that someone with an established academic reputation is brave enough to question and even refute some of the myths perpetrated by tobacco control activists.
A foreword and illustrations by Staddon's friend David Hockney have inspired reports in The Times and the Yorkshire Post. Hopefully they will help flog some copies but it would be a pity if they overshadowed the book itself.
Well-researched, with lots of useful references, Unlucky Strike is essential reading for anyone with an open mind and an interest in the war on tobacco.
Unlucky Strike - The Science, Law and Politics of Smoking, University of Buckingham Press, 111pp, £15
Reader Comments (4)
Sounds very interesting - not sure what Forest's budget is, but howabout sending a copy to every MP?
"When I read this passage in the original manuscript I felt a bit uncomfortable." Why bring Aids into it?
Simon, I think you might find this study from 2006 helpful in understanding.
Tobacco Control, Stigma, and Public Health: Rethinking the Relations - 2006
"The AIDS epidemic has borne witness to the terrible burdens imposed by stigmatization and to the way in which marginalization could subvert the goals of HIV prevention. Out of that experience, and propelled by the linkage of public health and human rights, came the commonplace assertion that stigmatization was a retrograde force.
Yet, strikingly, the antitobacco movement has fostered a social transformation that involves the stigmatization of smokers."
http://www.mailman.columbia.edu/sites/default/files/Tobacco%20Control,%20Stigma,%20and%20Public%20Health%20Bayer.pdf
"why doesn't government commission research to find out why some smokers live to a ripe old age with little sign of ill health, while others are more susceptible to 'smoking-related' diseases?"
A question I would like asked. Honestly, I've smoked since childhood. my body has evolved around tobacco as it has grown. How do I know I'd be better off quitting when the only study I've seen suggest people like me would be worse off.
As Octabber said : We want unbiased research that does indeed try to discover why some people live long lives as smokers and others don't. Just imagine if we knew before we even put that first cig in our mouths if our genes made us susceptible to a "related" illness or not.
However, public health would rather smokers died and tobacco was eradicated. In their eyes, that's the only way to solve what they perceive as a problem.
I care for smokers every day in hospital. A large majority of smokers become progressively, terminally ill from their habit, and use a disproportionate amount of public treasury (in spite of taxes paid on tobacco, which go elsewhere) on their way to death, through repeated visits to the emergency department and inpatient wards, while we try to treat what is essentially untreatable, merely prolonging the smoker's life, to allow more smoking...and ensuring more healthcare dollar expenditure.The same is now becoming true for overeating and obesity. I don't care what stupid, risky, irrational, abusive things people do to themselves as long as it doesn't directly cost me to clean up the mess. For instance, if a mountain climber needs to be medevac'ed out because he slips and falls, he (usually) pays the bill for losing the roll of the dice on his risky behavior. As I will, if I crash my Cessna in the Rocky Mountains.... However, I've given up trying to point this out to the smokers outside the entrance to my hospital, and just thank them for helping to keep our financially strapped hospital in business. Now let's talk about the motorcyclists who don't wear helmets, and that I'm also paying for their Brain surgery ....