Friday, May 6, 2011

How many diseases does it take?

It is not a secret that I dislike tobacco companies. Intensely. I do not see the point of allowing them to sell a product whose value is all in the negative. I am appalled that we are looking for expensive ways to diminish lung cancer mortality before considering a complete ban on this disease promotion apparatus. Yet this story in the LA Times got my goat. Briefly, a woman who has smoked for years and has had smoking-related obstructive lung disease since 1989 decided to sue tobacco companies after developing lung cancer in 2003. The suit has been making the rounds in various levels of courts, since the defendants asserted that she had exceeded the 2-year statute of limitations following the onset of her smoking-caused disease, referring to the 1989 COPD diagnosis. However, the California State Supreme Court has ruled that she can still sue the manufacturers, since she filed her suit within two years of the lung cancer diagnosis. So, why am I bothered?

Well, here is the thing: once you develop lung disease, followed by periodontal disease, as this woman did, had she really remained unaware that cigarettes are bad? That they cause problems? Is it really possible to live in our world and NOT be aware that tobacco kills? And if she was aware and continued to smoke, whose responsibility is it that she developed lung cancer, hers or the manufacturer's? Well, you say, but the tobacco companies are unethical and lied about making cigarettes more addictive by adding undisclosed ingredients. So, how are we, the consumers, to know? Well, this is pretty simple: We have free will, don't we? And if you have the free will, you have to exercise some will power, no? Is this not what the human condition is all about? Consider what would happen if we just let all of our desires run rampant. At the simplest level, who would want to get up early and do back-breaking work to produce food for our communities? And why contain anger at town hall meetings, when my humanity tells me to get into a brawl? These are basic ways in which we conquer our instincts and do what we need to do to live in a society with human beings and other organisms. But what is peculiar is that we have not extended these exercises of will to the area of consumerism. In other words, it seems to me that whichever way the market, and more importantly marketing, goes, so goes the perceived need for personal will and responsibility. Ergo, smoking despite warnings of its dire effects is OK, since the poor soul is addicted, and she can always sue on the back end, while the murderous tobacco CEOs and investors walk away with the profits. I don't know, I think it is embarrassing to give up your will that way personally.

There are two nuances to this view that I want to express. First, I do believe that cigarette companies are unethical, cruel and in debt to us, but the debt that needs to be paid is to the society, not to individuals. It is a debt to our public health that requires complete withdrawal of their product from the market and a large monetary compensation to promote healthy habits among human beings. Second, I believe that there are shades of this personal vs. societal responsibility balance that are important. Take, for example, food options for an inner city youth who lives in poverty. He may want to exercise his free will to get better nutrition than a $1.25 meal at McDonald's offers, or spend his $1.25 on an apple instead of a bag of potato chips, but for this he has to go across town, a trip that he does not have the means to undertake. This, folks, is where this young man's personal responsibility needs to be supplemented with societal commitment to equity.

So, should this unfortunate smoker with severe and life-threatening sequelae of tobacco abuse be able to sue the producer of the poison, even if she knowingly took the poison? I guess as a society we have decided that this is OK, but as an individual I am dubious. Yet it really is in the interest of our common health and wealth to punish and eliminate producers of such poisons as a society. Relying on individuals to do this job is just a perpetuation of the idea that we are not responsible for our actions. And furthermore, this becomes but a small pimple on this giant's ass, a nuisance, and not a necrotizing fasciitis that is required to kill it once and for all. 


  1. As a former smoker of 40 years, one who started at the tender age of 14 (at the urging of Humphrey Bogart and TV doctors), I have a bit more sympathy with the plight of the tobacco addict.

    It is hard, not impossible, but still very hard to stop.(P.S. I finally stopped 12 years ago)

    Usually we restrain our "instincts" for one of two reasons: 1. either we have developed enough intelligence or experience to know that the restraining will help us accomplish our aims better that letting go Or 2. we have been so intensely trained that the "big parent" in our minds will give us much trouble if we don't behave.

    Please consider how you might feel about this situation if the "victim" was a heroin or meth addict who was lured into shooting up as a teenager and the "dealer" was a smooth talking con-person who has a history of preying on the fantasies of the young and vulnerable.

    If the "dealer" image of the tobacco companies as dealers seems too harsh, I recommend reading Allen Brandt The Cigarette Century.

  2. Dear Anonymous, I fully sympathize with your view. In fact I do view tobacco companies as the predatory dealer that you describe. However, where I differ slightly from you is in my conviction that as a society we are enabling these dealers by investing in them and allowing them to lure the young and the naive. Yet there is something to be said about taking personal stock in one's own stake in the habit that is certainly not easy but not impossible to quit.

  3. Thank you for your reply.

    Plenty of room in my world view to encourage the development of personal responsibility. My point in describing the situation of many smokers is simply to encourage sympathy for their plight. To me, sympathy does not entail permissiveness.

    It is kind of like saying, "Yes, I know you were lured into (alcohol, drugs, tobacco, sodas, junk food, risky sexual behavior,etc) and I am sorry about that. Now what are you/we going to do about it? How do you think I can help you best?

    Several weeks ago Frontline had a very disturbing and powerful program on decades long sexual abuse of Native American children in Alaska by members of the Catholic Church. Those children grew up feeling largely responsible for what happened and not knowing how to resolve their anxieties and destructive patterns.

    Compared to the abuse situation, the smokers' dilemmas seem trivial but in both instances the victims feel fundamentally weak and guilty. In both instances, learning how the institutions deliberately cultivate weaknesses is an important path to overcoming. This process happens much more rapidly when there are others who understand and sympathize at a deep level.

    Powerful and 'prestigious' institutions and person in our culture frequently prey upon our needs and vulnerabilities. Yes, people need to take responsibility, but notice: "response" and "ability." Many have never learned or have a poorly developed "ability" to "respond" in an appropriate effective manner.

    When people who are not caught in a particular vicious cycle, truly understand and sympathize with those who are, they will become enablers in the most positive sense of helping victims overcome and go on to become positive enablers themselves.

  4. Don't forget about another important player in this story - the tobacco farmer. Victim or Accomplice? I found this blog post relevant and interesting:

  5. And what about diagnostic tools and treatment? No mention of it. Do we just keep pushing lung CA patients to the fringes of "overall healthcare" because it was their failure to control their addiction?
    We find no problem pouring billions of dollars into cervical screening, HPV research and vaccines- yea hah (sincerely) etc. But only recently have we seen good research on lung CA screening. Current treatment and surgery has crappy outcomes. For many years public health has reached out to educate women abut risk behaviors that lead to HPV exposure/infection and cervical cancer. Shall we give them the talk about having more 'control' over their sexual activity?  This discussion reminds of the cynical conservative stance on funding reproductive health services for women. "We will do our damnedest to legislate your reproductive choices, restrict access to abortion, but no, we won't support access to gyn/ob care and birth control."
    Shame on us.