A Libertarian Approach to Anti-Smoking Letter in the NYT

On Friday morning, the New York Times published a guest editorial by Peter B. Bach, a pulmonary physician who directs the Center for Health Policy and Outcomes at Memorial Sloan Kettering Cancer Center in New York. The piece, which is called “The Tobacco Ties That Bind,” deals with the relationship between the American Cancer Society and vendors of tobacco products.

I don’t smoke, but if during the day I wanted to buy cigarettes, I could walk into the CVS pharmacy across the street from my office, or the Walgreens two blocks away, and get them. They’re kept right behind the cash register.

But beginning this fall, that is going to change. CVS pharmacies will stop sales of all tobacco products. Walgreens, well, won’t.

So, here’s a quiz. Which chain do you think is more heavily celebrated on the website of the American Cancer Society ? Well, it’s not CVS. Instead, testimonials and profiles hailing Walgreens abound. There is a glowing profile of the Walgreens chief executive that focuses on his tireless efforts to promote healthy living in his workplace and stores. There is no mention of the tobacco sales at the front of those stores.

This, Dr. Bach argues, is no oversight. Although the American Cancer Society highlighted the CVS decision to cease sales of tobacco products, it also refused to sign an open letter that requested that other pharmacy chains do the same thing. Dr. Bach also notes that his own hospital, MSKCC, holds charity events which are sponsored by Duane Reade, a New York City subsidiary of Walgreen’s. In other words, programs that are devoted to curing and ending cancer are accepting money from organizations that are involved in the sale of tobacco products.

None of this represents a conspiracy, obviously, and Dr. Bach accordingly takes a sober approach to all of this different information:

Yes, fig-leafing is widespread. Companies regularly donate money to charities and earn awards and recognition for doing so, even as some of their practices undermine the very goals of the charity they support. Oil companies donate to environmental causes even as they ravage the environment.

Certainly Walgreens has shown leadership in offering antismoking programs to its employees and customers. But at the end of the day a corporate vision “to be the first choice in health and daily living for everyone in America” is incongruous with selling the leading cause of preventable death at your cash registers.

All of this, so far, makes sense. I can see why organizations such as CVS would make a $2 billion commitment (in terms of revenue lost) to removing cancer-causing products from their stores, and I can also see why organizations such as Walgreen’s would be hesitant to make such a move. The latter, for better or for worse, makes even more sense when you consider that Walgreen’s will likely capture increased tobacco sales as CVS customers go to other pharmacy chains in the future for their cigars and cigarettes. And, as the article itself does point out, the fact that Walgreen’s observes a commitment to healthy living in other areas and offers antismoking programs for employees counts for something, too.

I also see why the American Cancer Society and MSKCC–along with probably many other similar organizations–accept charitable funding from Duane Reade, Walgreen’s, and any other vendors of tobacco products. At the end of the day, it is difficult to turn down more research funding when we are in such desperate need of new cures and treatments. And I see why this ruffles the feathers of individuals such as Dr. Bach, who use methods such as public awareness to try and pressure these organizations into behaving differently. I’d say that reasonable people can disagree on everything in this paragraph and the one above it.

And now to my point. As the Director of the Center for Health Policy and Outcomes at MSKCC, I’m sure Dr. Bach has forgotten more about health policy in the past few hours alone than I’ve learned in my entire young life. That being said, I do have to say that the case he makes for “reducing the convenience of buying cigarettes” seems to be based on an incomplete consideration of the consequences such a policy might hold.

Making it harder for people to smoke yields enormous health benefits; some are nearly immediate. When the city of Helena, Mont., instituted a ban on smoking in the workplace and public spaces, rates of admissions for heart attacks fell about 40 percent over six months, only to rise once the city stopped enforcing the law. Were the Cancer Society to publicly call on its donor to follow CVS’s lead, others such as Rite Aid would feel enormous pressure to fall in line.

Limiting sales and reducing the convenience of buying cigarettes would reduce smoking rates, particularly among the young. But don’t believe me; you can read this same assertion on the website of the American Cancer Society .

I am not familiar with the Helena case that Dr. Bach cites and unfortunately do not have the time to look it up at the moment, but I am willing to take the expert at his word here and assume that his explanation of it is accurate. It’s not like the outcome is surprising, anyway–most of us would probably expect certain measures of “healthiness” to increase over time, ceteris paribus , as a population starts to smoke less and less. And, even though many libertarians might object to smoking bans in public places and workspaces, it’s not all that distortionary of an intervention. I would guess that many, if not most, corporate workplaces observe such bans themselves even in the absence of government edicts. We can argue about whether or not any space can truly be “public” and whether or not people should be allowed to smoke in such a place, but that’s a different conversation.

No, what I’m getting at here is that Dr. Bach’s prescriptions seem vague, and it’s not long in any conversation about limiting cigarette sales that the idea of a total ban on tobacco products gets brought up somehow. Again, there are basic libertarian positions on bans, taxes, and freedom of choice that can be made here, but I think the best way of weighing a potential tobacco ban across different political viewpoints is by examining its unintended consequences. In New York City alone, for instance, attempts to limit cigarette sales via taxes and age restrictions have resulted in a booming black market, in which 60% of the cigarettes smoked in the city are smuggled in and bought and sold illegally.

I’ve written before about an in-depth and informative 2003 policy analysis from the Cato Institute that showed that past efforts in New York to dampen tobacco markets resulted in violence and bloodshed, with smugglers linked to organized crime and even, in some cases, organizations such as Hezbollah. This is certainly shocking but it is less surprising when we consider that the prohibition of drugs and alcohol have had similar effects.

It is worth noting that the numbers Dr. Bach cites–a 40% reduction in rate of admissions for heart attacks over a six-month period following a smoking ban–constitute only one measure of societal well-being. The fact that New York City is already experiencing such a struggle with black markets for tobacco products demonstrates there is no silver bullet for ameliorating the woes we experience from the adverse effects of tobacco usage. A ban may save lives and money in one area but cost us both in another, and it is difficult for a small group of legislators to weigh those realities in a way that represents the interests of everyone whose well-being is involved.

To be clear, nowhere does Dr. Bach express support for any sort of outright ban on cigars, cigarettes, and/or other tobacco products (though he certainly seems to support the bans instituted by the government of Helena, Montana). He seems here to be favoring a means of promoting change that involves educating citizens and focusing the public’s attention on large organizations in order to pressure them into altering their behavior, which is an approach that most libertarians would probably view as superior to state intervention. I would encourage him to continue pursuing this method of attempting to influence others to change their ways voluntarily, and to perhaps reconsider any more centralized solutions that he might be entertaining.

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