Tag Archives: cigarettes

Cigarette Smoking Kills: Should Missourians Vote Yes To Raise Cigarette Taxes?

Recent statistics show that cigarette smoking is  responsible for 167, 133 cancer deaths annually in the US or 29% of all cancer deaths.

Cigarette smoking also kills annually in the US  160,000 people by promoting cardiovascular disease.

Thus, from a health standpoint we should be doing everything possible to stigmatize and make more difficult cigarette smoking.

One approach to this is to tax cigarettes, raising the financial burden of smoking. Across the US, therefore, states have added cigarettes taxes which average 1.65$ per pack.

My state of Missouri has the lowest state tax on cigarettes of 17 cents per pack. Multiple ballot attempts to raise this amount have failed in the past.

However, on this Tuesday’s ballot there are two competing options that we can  vote on that will raise cigarette taxes: Amendment 3 (raises cig taxes  60 cents and earmarks funds for a newly created Early Childhood Education and Research Fund) and Proposition A (raises taxes 23 cents and earmarks funds for infrastructure.) (Links are to Ballotpedia, a reputable source of information nationwide.)

I’ve been researching both of these proposals over the last few days since receiving an email from a physician colleague urging  me to vote no on Amendment 3. Remarkably, a coalition of health organizations (The American Cancer Society Cancer Action NetworkAmerican Heart AssociationAmerican Lung Association in MissouriCampaign for Tobacco-Free KidsHealth Care Foundation of Greater Kansas City and Tobacco-Free Missouri) has come out against the propositions to raise cigarette taxes with the following statement :

Small increases to the tobacco tax – like the proposals being considered – will generate new revenue, but will not keep kids from becoming addicted to cigarettes or help adults quit.Tobacco taxes work when the price increase is substantial enough to motivate current smokers to quit and prevent kids from starting. A dime here or there is not sufficient. Tobacco companies are adept at finding ways to absorb small tax increases through adjusted pricing. What’s worse, these marginal increases could hamper future efforts; promising profitable returns for the tobacco industry at the continued expense of Missourians’ health…

Tobacco products in Missouri are too cheap and the health costs are too high. Our state is long overdue for a tobacco tax increase, but it needs to be one that will make a difference and save lives. A meaningful tobacco tax increase – of $1.00 per pack or more – has proven time and again to be an effective way to reduce tobacco use, cut healthcare costs and generate state revenue.[7]

Our local public radio station had a good discussion recently which is summarized here.

I found the PRO comments of Jane Dueker particularly persuasive as summarized below:

PRO: Jane Dueker wants people to vote “Yes” on Constitutional Amendment 3. Here are her main points:

Jane Dueker is a proponent of Constitutional Amendment 3.
CREDIT KELLY MOFFITT | ST. LOUIS PUBLIC RADIO
  • This tax would provide $300 million in funding for early childhood education, healthcare and smoking cessation programs. Right now, Missouri can’t even fund the K-12 Foundation Formula, so any extra funding is needed for early childhood education.

  • By filing this as an amendment, we were able to make a constitutional “lock box” that would keep the legislature and special interests from taking money that is specifically dedicated to this fund, like what happened with lottery funds.

  • Right now, only 3 percent of 4-year-olds in Missouri are in a publicly-funded preschool. Missouri is behind states like Oklahoma with 76 percent, Illinois with 27 percent and Arkansas with 38 percent.

  • Higher tobacco taxes have failed in 2002, 2006 and 2012. This is more reasonable and we don’t have a clause that says another tobacco tax could not be added on top of this one to give that “sticker shock” to consumers.

  • This closes a loophole that kept cheap cigarette companies from paying their fair share into a 1998 court settlement to recover some of state governments’ tobacco-related health-care costs. Now, smaller tobacco companies would pay a 67-cents-a-pack hike on low-cost cigarettes in addition to the 60 cent tax on all cigarettes. This would give Missouri $1 billion annually we currently don’t get. Missouri is the only state that hasn’t closed this loophole and the state is a “dumping ground” for the cheapest cigarettes in the country.

  • Groups that oppose this either think the tax is not high enough (health groups) or that they don’t get money from this fund (pro-choice and research institutions).

  • Missouri’s Foundation Formula public school funding starts at kindergarten and cannot fund early childhood education. This money could go to public or private early childhood education entities in a way it would not be distributed through the foundation formula.

  • $15-30 million dollars would be raised through this tax that would go to smoking cessation programs.

  • The fund will be administered by a board of unelected people because they have special experience in early childhood education. A “person of faith” is required on the board because of their position as a community anchor.

At this point, I’m leaning toward voting yes on Amendment 3 but confused as to why RJ Reynolds is supporting it to the tune of 12 million dollars and the “good guy” health organizations oppose it. I’d appreciate any input/comments on this from readers. I strongly urge everyone to read and learn as much as you can about the issue before walking into the voting booth.

By the way, I recently observed this Canadian cigarette package img_7957which I think excellently conveys the horror of cigarette smoking.

Truthily Yours

-ACP

Some more  stats to ponder from the CDC

Cigarette smoking causes premature death:

  • Life expectancy for smokers is at least 10 years shorter than for nonsmokers.
  • Quitting smoking before the age of 40 reduces the risk of dying from smoking-related disease by about 90%.

Exposure to secondhand smoke causes an estimated 41,000 deaths each year among adults in the United States:

  • Secondhand smoke causes 7,333 annual deaths from lung cancer.
  • Secondhand smoke causes 33,951 annual deaths from heart disease.

Is Not Wearing A Bike Helmet As Stupid As Smoking Cigarettes?

IMG_4261
The “Route” from my house to the great urban park, Forest Park, around and back. Sans incursions into the dangerous paths less traveled

Several weeks after  my cycling misadventures which resulted in non cardiac chest pain, I climbed back in the saddle again and rode the route that had resulted in my calamitous fall.

This time, I avoided the mysterious path less traveled.

As I approached  Washington University an elderly man riding a bike and wearing a bike helmet came up beside me. He was clearly very irritated by the fact that I was not wearing a bike helmet and kept gesticulating at his helmet to indicate that this was the proper choice of head gear.

I had, as is my usual practice, chosen not to wear a helmet  and this man had taken it upon himself to nonverbally lecture me on what he perceived was inappropriate risky behavior.

As I continued my ride I began ruminating on my decision to engage in  bike riding without a helmet and wondering if I was being like my patients who continue to smoke cigarettes despite my warnings of the health consequences of that behavior.

There can only be two reasons for an educated person not to wear a helmet:

1. S/he believes there is no or insufficient evidence that wearing a bike helmet will reduce their risk of serious head injury while riding.

2. S/he accepts that helmet wearing reduces injury but is willing to accept this risk because not wearing the helmet is more pleasurable or convenient.

Similarly, my cigarette smoking patients may either reject the (overwhelming) evidence of the dangers of this behavior or they may believe it is dangerous but feel that smoking is so pleasurable they decide to continue.

Not wearing a bike helmet lacks the addictive element that cigarette smoking contains but otherwise I think it is a reasonable analogy.

Do Bike Helmets Reduce Injury ?

Despite widespread public health advise to wear bike helmets, I have maintained  in previous posts that evidence for bike helmets reducing injury is lacking.

I’ve spent a fair amount of time since this gentleman upbraided me for being helmet-less reviewing the data again. I was prepared to regularly wear one if the data supported it. But it doesn’t.

A commonly cited statistic is that bike helmets reduce serious head injuries by 85% and brain injuries by 88%.  This comes from an observational  study  published in 1989 which has serious limitations and has never been reproduced. For an exhaustive critique of these data see here.

I think a fair summary is in this British Medical Journal editorial which is behind a paywall but can be reviewed as a PDF here (bmj-june-2013.pdfbicycle helmets and the law)

Cowritten by David Spiegelhalter, the Winton professor for the public understanding of risk at the London School of Hygiene, the editorial was commenting on a paper in the same issue which reported that a Canadian mandatory bike helmet law had minimal effect on cycling-related head injuries.

The writers note that this contradicts previous observational studies which have suggested a benefit from helmet wearing.

Like all observational studies, these bike helmet studies are “vulnerable to many methodological shortcomings”:

  1.  If the controls are cyclists presenting with other injuries in the emergency department, then analyses are conditional on having an accident and therefore assume that wearing a helmet does not change the overall accident risk
  2. Observational studies cannot account for confounding variables that are unmeasured. For example, people who choose to wear bike helmets may be more cautious than those who don’t and so less likely to have a serious head injury regardless of wearing a helmet. (A 1997 study found that adolescents who smoked cigarettes were more likely to use smokeless tobacco, have multiple sexual partners, and not use bicycle helmets)

Many states and countries have passed laws mandating helmet wearing but people who are forced by legislation to wear a bike helmet may wear it in a sloppy , ineffective manner. Their behavior may also change   through “risk compensation” wherein they behave more irresponsibly in the believe that they are protected from injury.

A single study has also reported that car drivers give a larger clearance to cyclists without a helmet.

I have concluded that my not wearing a bike helmet is due to lack of evidence to support the health consequences of that behavior. This happens to perfectly align with my disdain for bike helmets which chafe my forehead, make my head sweat and reduce my ability to hear (both charming and lethal) things.

Do Cigarettes Cause Death?

Cigarette smokers, on the other hand, can find no serious scientist or physician who is not convinced of the danger of this lethal habit because the scientific data are overwhelming. The CDC estimates cigarette smoking is responsible for 480,000 deaths per year and that it causes 90% of lung cancers and 80% of chronic obstructive lung disease. The only possible explanation for continuing is the element of addiction combined with the pleasure obtained from smoking.

Public Health Laws: Bike Helmets and Cigarette smoking

Australia and New Zealand are the only countries to have mandatory helmet laws. In the US, according to helmets.org, bike helmets are mandatory in 22 states.

In St. Louis County, they are mandatory for children under the age of 17. In some St. Louis municipalities (Creve Couer for one) they are mandatory for all are groups.

To date, there is no evidence that mandatory bike helmet laws reduce head injuries so why are they being passed?

On the other hand, the dangers of cigarette smoking are clear and there are no countries or states which make it illegal.

To those who would shame we non helmet wearers I say: “Spend your time shaming those who smoke cigarettes”.

By the way, whenever public policy doesn’t seem to correspond to the evidence, we should look for bias and special interests.

It’s obvious in the world of tobacco that the bias and special interest  toward allowing smoking comes from the tobacco industry.

In the cycling world, the bias and influence comes from the manufacturers of bike helmets.

Helmet free and loving it

-ACP