July 17, 2001

6:58 AM

Smoking creates "indirect positive effects."A report from tobacco giant Philip Morris concluded that the Czech government saved money because of the "indirect positive effects" of the early deaths of cigarette-smokers. PM makes about 80 percent of the cigarettes smoked in the Czech Republic. Said a Philip Morris spokesman: "Tobacco is a controversial industry, but we are still an industry and sometimes we need some economic data on our industry."
posted by tranquileye (39 comments total)

I posted a link to one of the first stories on the matter, from the Prague Post, on World New York a couple of weeks ago. My uncle (hey, all traffic is good), who is a hospital administrator in Illinois, responded with this:

"This makes perfect sense to me and illustrates the fallacy of thinking that improving people's health will decrease the costs of healthcare. When we improve our health we live longer, and no matter how healthy you are, the older you get the more things go wrong with you. All of those things require drugs or surgery or doctors or therapists and they all cost money. So if we want wellness, let's want it because it is good to be well. Let's remember though, it comes at a price too."

My opinion on this is a step beyond my uncle's, and actually what I think he was trying to say: stop letting the cost of something be the primary reason we are for or against things. As one of the people quoted in the Prague Post story says about the conclusion of the Philip-Morris study, "Following that logic, the best recommendation to government would be to kill all people on the day of their retirement."
posted by Mo Nickels at 7:47 AM on July 17, 2001

> "Even if it were true that smokers dying young would
> save money for the economy, it's a real scary logic on
> which to base policy," said Patti Lynn, associate
> campaign director for corporate watchdog group Infact

But it's the coming thing, not just for old smokers but old people in general. With world population what it is, now that the abortion battle is pretty much over except for some skirmishes with holdouts it's onward to euthanasia.

As easy as it's been to persuade large numbers of people that homo sapiens below a certain age aren't human yet and may be aborted, how hard could it be to persuade the same people that Homo sapiens over some specified age aren't human any more and may be euthanized? Predicted answer: not too hard at all. You may be shocked but your kids won't be.
posted by jfuller at 7:52 AM on July 17, 2001

Time taken until someone argues that a blastula is a human being: 5 minutes.

Anyway, here's a thought: shouldn't the US government begin touting the indirect positive effects of its policy of allowing poor people to die rather than help them get shelter, food, or medical care? Slashing all of our benefits and programs will in the long run save us money. Yippie!
posted by Ezrael at 7:56 AM on July 17, 2001

> Time taken until someone argues that a blastula is a
> human being: 5 minutes.

Soylent Green is people, dude. Blastulae and others...
posted by jfuller at 8:01 AM on July 17, 2001

"Following that logic, the best recommendation to government would be to kill all people on the day of their retirement."

Logan's Run, anyone? You know, only slower :)

At the basic level, this is true. Retired people typically consume without producing. I'm not sure that world population is a problem, though. In some places it is, but most of the world is relatively population free. I mean, we haven't even started building floating cities yet, and 2/3 of the damn world is covered with ocean (and a buttload of the world's protein lives in there, too).

But (back to the thread), I disagree with the onward to euthanasia bit - if anything, we're headed in the other direction. Old people lives longer and better lives, by and large, than the previous generation, and that will only get better as the Baby Boomers slide toward their demise. At the same time, economics is forcing old people to work longer - social security is not just dying because of a population shift, but also because people are living so damned long.

Overall, however, it's the denial of harsh realities - like that smokers die earlier and save the government money, among many others - that ends up causing problems down the road. Life is not always nice. Sometimes, it's hard. It's far past time for us as a culture to stop bullshitting ourselves about every unpalatable point of fact.
posted by UncleFes at 8:09 AM on July 17, 2001

There could be no better peacetime indictment of cost-benefit analysis.

(Of course, 'collateral damage' takes the cake, but still.)
posted by holgate at 8:29 AM on July 17, 2001

Actually, UncleFes: There are millions in medical bills that aren't being considered there (cancer tends to produce the highest sort), increased insurance rates, lost tax dollars (yes, millions of elderly people pay taxes, still), etc.
posted by raysmj at 8:30 AM on July 17, 2001

Taking the hard logic approach to this, it seems ridiculous that they needed a study to determine a dead person isn't costing you as much money as an alive one.
posted by Sellersburg/Speed at 8:52 AM on July 17, 2001

The novelist Lawrence Sanders (in a great book called "The Tomorrow File") offered a creative solution to this problem. He proposed that elderly people, after receiving proper counseling & signing forms assuring that they knew exactly what they were doing, could enter into what he termed "Government Assisted Peace." By signing the GAP form, the senior citizen would receive a nice chunk-o-change (different valuation of currency in this future, so unsure of amount) from Uncle Sam which could be used in any manner the senior desired. Thirty days later, the senior would be euthanised. See? Everyone wins - the government gets an expensive person off of the retirement & healthcare rolls, the senior citizen can live out his/her last days in a carefree romp or give some $$ to heirs. Chilling, isn't it?
posted by davidmsc at 8:56 AM on July 17, 2001

My understanding was that smoking tends to cause lung cancer, which metastatizes fast and has one of the lowest survivability rates (around 15%) of all cancers.

One of the hooks here is that, although I can find that 85% of lung cancer patients are smokers, what is the percentage of smokes who get lung cancer? My brain wants to remember 40%, but that is a WAG.

Remember also that overall long term mortality rate for humans is 100%. Even if you eat right, don't smoke, exercise, have good genes and all that - you are still going to die. Sorry, but it's true. Considering that, what difference does it make to the Big Picture whether smokers die of lung cancer or heart disease? Whether you die of car accident or old age? My contention being that, since we're all going to croak eventually, and a certain percentage will go fast and a certain percentage will go slow regardless of individual behavior, wouldn't the sheer numbers normalize the costs? All those smokers who quit will eventually die of something; could be that they need lots of medical care, could be that they drop dead of natural causes at 65 with a minimum of fuss. But if you target one set of behaviors, where do you stop? How much do you want me to change my individual behavior to minimize my use of medical services? And can we really even say with any authority that, yes, smokers use more medical services than non-smokers AND, if we can, don't we already modify the cost structure to take that into account?

So what's the problem? Bum me a smoke, will you?
posted by UncleFes at 9:06 AM on July 17, 2001

UncleFes: Well, OK. No need for the smarty pants ending. You didn't address the entire note, and I found no hard, objective facts in your response. Also, can you really put a value on human life? Y'know, some people like having their relatives around, some people get addicted and mean to quit but never do. Also, there is plenty of evidence that even smoking in "moderation" or just for a few years can kill you. You can stop, but it'll still come back to haunt you later. Quitting only lowers the chances of something bad happening.
posted by raysmj at 9:14 AM on July 17, 2001

Chilling, isn't it?

When's the chilling part come in?

What's chilling is seeing dozens of old people warehoused in nursing homes where they are abused, robbed, assaulted and ignored. Which is worse? If it comes to that for me (like a terminal diagnosis of Alzheimers or something equally ugly and final) I would grab onto that 30 day thing like a drowning man on a rope. And be glad to have it. I've seen people dying of Alzheimers. I hope that, if there is no GAP form for me, that I have the moral courage to do the right thing and take the vaunted long walk off the proverbial short pier before I bankrupt my family and force them to witness my slow descent into madness.

No need for the smarty pants ending.

Ok, sorry about that. Sometimes my wiseass side resists being repressed.

You didn't address the entire note, and I found no hard, objective facts in your response.

Well, that's true too. I was just speculating on the big picture economics of long term health care for a large population. And I quit smoking for the exact reasons your describe - I want to be around for my family. I was noodling a bit there. BUT I think the point is valid - it would seem sensible that individual cases are irrelevant to the larger picture. Health care for 250 Million people costs X amount regardless of whether I personally die of cancer, or heart disease, or tree falls on me.

And I agree with you - human life is hard to value. Because it's worth is so changeable. For some, it might not be worth much; for others, nothing could be more valuable. The point being, if smoking is worth it to me, and the costs of my health care are both passed back to me (in the form of higher insurance premiums) and normalized in the larger population, why should anyone criticize? Let alone use the courts, advertising and a onerous tax structure to try and get me to quit?
posted by UncleFes at 9:33 AM on July 17, 2001

Let me rephrase that: why should the government criticize, and use the courts, advertising and an onerous tax structure to get me to quit?
posted by UncleFes at 9:42 AM on July 17, 2001

UncleFes: How many smokers actually know, or have known, that quitting today will only *lower* their chances of getting cancer? You've had people on here say, oh, I can smoke until I'm 24 and my body can handle anything until then, so it's OK. Then there's moderation, blah blah. Insurance costs from smokers are not just passed on to smokers, by the way, and then there's the second-hand question. Then you didn't even address the addiction question. Also, the government, to my knowledge, has never been harshly critical of smokers. (Even the nasty, "Smoking is glamorous," posters of the '70s were produced by the American Lung Association, if I remember correctly.) We've gone over this before on here. It's the culture that has taken up the hostility thing.

Also, for gosh's sakes, you know smoking is likely to cause cancer or some other illness. The illnesses it produces are *preventable* - unlike, say, getting hit by a tree or struck by lightning or even hit by a car, since you have to drive if you want to get anything done in at least 97 percent of America.
posted by raysmj at 9:55 AM on July 17, 2001

> getting hit by a tree

The trees around here are especially violence-prone just now.
posted by jfuller at 10:17 AM on July 17, 2001

> But (back to the thread), I disagree with the onward to
> euthanasia bit - if anything, we're headed in the other
> direction. Old people lives longer and better lives, by and
> large, than the previous generation, and that will only
> get better as the Baby Boomers slide toward their
> demise.

Actually I expect China or somesuch place to lead us into this particular brave new world -- with or without help from Philip Morris.
posted by jfuller at 10:21 AM on July 17, 2001

Soylent Green is people, dude. Blastulae and others...

That means I have a living human being in my skull and brain. Because there's a slightly more than blastula-developed fetus permanently lodged there. I'm two people! I'm worth twice anyone else!

I wonder if the inexorable lengthening of human life will have side effects we haven't considered. With us living longer and longer, and replacing ourselves while our ancestors are still here, will we eventually create a society where your great-great-great grandparents are still alive, and perhaps even expected to work until a retirement age of say 127?
posted by Ezrael at 10:38 AM on July 17, 2001

"There may be only one."
posted by Sellersburg/Speed at 10:53 AM on July 17, 2001

How many smokers actually know, or have known, that quitting today will only *lower* their chances of getting cancer?

I knew. I assume others know. It’s not a secret. The information on the dangers of smoking has been widely available for a couple decades. But if you’re really trying to cure willful ignorance, you’ve got a big job ahead of you.

Insurance costs from smokers are not just passed on to smokers

True. But they are also passed along for diabetics and blind people. Insurance is supposed to cover everyone, regardless of affliction. The real deal is that insurance costs for sick people are passed along to well people. Not all smokers are sick – not even most are sick - but they all pay higher premiums because they smoke.

there's the second-hand question

Yes, although as I recall that has been somewhat discredited of late. In any event, it may be a justification for sending smoking outside, but not for much other than that.

Then you didn't even address the addiction question

It’s moot, is why I didn’t address it. The current methods available for breaking tobacco addiction are adequate, as far as I can tell. Why is it a tragedy when someone addicts themselves to cigarettes, but a crime when someone addicts themselves to heroin or crack?

The illnesses it produces are *preventable*

Indeed they are, but so what? So are a LOT of illnesses. Here’s an analogy: a mother decides that, because she believes that immunizations cause autism, to not get her child a shot. He subsequently contracts measles. Totally preventable – but shouldn’t that kid get to go to the hospital, too? Heart disease kills far more people than lung cancer – yet McDonald’s is not the subject of a Justice inquiry, nor does the government see fit to increase the taxes on Bic Macs, or ban their advertising. Why? Car accidents (totally preventable) cause thousands of deaths a year – should your health insurance be higher because you drive a car?

If we are devoted to personal freedom and concomitant responsiblity, then we should leave smokers alone and treat their illnesses like we would any other illness. If we are devoted to preventing illness, then we shouldn't single out cigarettes when there are so many other behaviors that are just as (or more so) dangerous.
posted by UncleFes at 11:33 AM on July 17, 2001

UncleFes: Last thing I'll say. Haven't you heard, over and over, that cigarette-smoking causes the most easily preventable illness of any possible product, lifestyle or habit, etc.? This strikes me as contrarianism for the sake of it, with nothing fresh or relevant to add.
posted by raysmj at 11:42 AM on July 17, 2001

Car accidents are not totally preventable, if you're not the one causing the accident. And even then cars sometimes have flaws which cause accidents. Hamburgers contain many nutrients which, taken in moderation, can actually be good for you. Red meat contains lots of protein. The same can't be said of tobacco. In any case, I believe lots of info has been put out about the above, a lot of societal effort has gone into getting people to eat better.
posted by raysmj at 11:46 AM on July 17, 2001

And haven't you heard me acknowledging that and making a totally different point? Yes, smoking is unhealthy, and preventable. On that point, the evidence is very strong - it is why I quit smoking. However, we're talking about "indirect positive effects" here, like that smokers die before they rack up health costs. My point is that health costs and mortality demographics are bigger than smoking.

I apologize for the contrarianism, lack of freshness and irrelevance. I assumed this was a discussion of differing opinions.

Red meat contains lots of protein

Nicotine contains stimulants that help speed electrochemical interaction in the brain. Parse all you want; it's not the point I was trying to get across.
posted by UncleFes at 11:55 AM on July 17, 2001

UncleFes: That's not a health benefit. That's a mental health benefit, but not a physical health benefit. It doesn't keep anyone alive long. Then what was your point, exactly? It sounded to me like just trying to poke apart efforts to get people to quit smoking, and doing so in whatever miniscule or contrary means possible. Opinion is one thing. But what about informed opinion, or fully examined opinion?
posted by raysmj at 12:03 PM on July 17, 2001

also, hamburgers aren't addictive.
posted by rabi at 12:04 PM on July 17, 2001

Ray: I don't care if people smoke or not. If people want to quit, they should do so. Hell, I quit, for exactly the reasons you mention - it's lethal. My point was that the way the health insurance system works is (a) smokers are charged extra, and (b) illnesses - whether they are related to smoking or not - are treated and those treatments generate costs that are normalized by the size of the population - the more people in the population, the better able that population is to expend the money necessary to treat those who get sick. If you assume a sufficiently large population, those costs of treating smokers' illnesses are insufficient to skew the overall cost of treating all illnesses. Therefore, whether or not people smoke does not matter to the overall cost of health care. In fact, the Czech study seems to indicate that smokers don't live long enough to add much to overall health care costs. If that is true, then why is the government so hot to get people to quit smoking? My opinion is that government anti-smoking efforts are unrelated to any deliterious health care cost effects. Therefore, it should be an individual choice to smoke or not or quit, based on individual factors, rather than health care costs.

That's not very contrarian..? I think it's even somewhat informed, and marginally examined.

also, hamburgers aren't addictive.

Alright, assume that they aren't. But coffee and tea are. Where's the outrage against Starbucks?

In any case, my point is that it doesn't matter whether you smoke or not in the grand schema - it only matters to you and your loved ones, and it is there that the decision to smoke or not should be made.

Personally, I think it should be within someone's rights to do something they know can be harmful (and ultimately fatal) to themselves if they want to. Skydivers do - why not smokers? I think it is unfair that smokers are singled out for their behavior when other dangerous behaviors are not.

[takes deep breath] and THAT was my point :) Sorry Ray, takes me a minute to get around to it.
posted by UncleFes at 12:35 PM on July 17, 2001

Oh just for the record, UncleFes, not trying to sound insulting. But the more I read and learn about cigarettes (former smoker here), the more I realize people don't know how bad they really are, the more I wonder why they're kept around in any fashion. Also, lotsa vitamins and exercise can help with the focusing thing. (And if you get desperate at first there's always generic nic gum! For a while at least.) They only need to be phased out, which might take a century or more, but . . . It would seem to me that one can argue whether govt. policy and lawsuits, etc. will really have that effect, but the more general goal of cutting smoking rates seems impossible to call wrongheaded.
posted by raysmj at 12:36 PM on July 17, 2001

The states take a huge chunk for Medicare, Fess, always have. And not (definitely not) all group/employer plans punish smokers.
posted by raysmj at 12:39 PM on July 17, 2001

Another study with alternative facts re the cost to society of tobacco. Left out in the posted study are: Lost manhours, fires started by smokers (25 percent of all residential fires), etc.
posted by raysmj at 12:55 PM on July 17, 2001

but the more general goal of cutting smoking rates seems impossible to call wrongheaded.

I agree - nothing at all wrong with trying to educate people to the dangers and reduce the number of smokers. And I think that you will see them disappear, at least in America, within the 21st century.

I guess overall the sideshow to the whole smoking thing is that we as a culture are seemingly unable to stomach some of the more unpalatable truths - like smoking causes you to die early, thereby relieving the health care industry of your long-term care. I think we saw this exact same thing in the study that showed that crime rates reduced at rate comparable to abortion becoming legal. Some truths are just too tough to handle. The problem is that we ignore these truths at our peril. A good analogy is the social security mess - we ignored the population demographics and the 1% return on funds until a crisis brewed. Now, it's going to end up being too late to solve the problem without some real fiscal pain on both sides of the equation.

I quit when I got the flu and then had my wisdom teeth taken out, all inside of a month. I hadn't had a smoke for some 3 weeks, figured if I was going to quit this would be the best time. It took :)

Ah, hell, Ray, they're going to find a cure for cancer in a few years and you and I are going to be able to smoke up as much as we like :)

The states take a huge chunk for Medicare, Fess, always have. And not (definitely not) all group/employer plans punish smokers.

The first part is true - the Medicare liability is growing faster than SSI, and will eventually prove to be a worse problem. The second part, I asked our Group Health division: If you buy individual health insurance, you pay extra if you are a smoker; but as part of a group plan, you do NOT (!!). "It all comes out in the wash," they said. I'll be damned. They don't care if we smoke.

I'm not sure who's position that helps...?
posted by UncleFes at 1:24 PM on July 17, 2001

Non-controversial post alert: And of course, UncleFes, they can't know if everyone's smoking. Pat Nixon was a closet smoker. Always wondered about that term. She smoked in the closet? Weren't any microphones there, I suppose.
posted by raysmj at 2:32 PM on July 17, 2001

Uncle Fes-Just as a side point. I live in New York which is jam packed with smokers. They may not be able to smoke inside any buildings, but they still smoke. They huddle outside of their jobs during blizzards and rain storms. They pay five dollars a pack. These people are dedicated to cigarettes. I saw a well dressed teenager pick a cigarette off the sidewalk and light it up! On any given day walking around, I think about seventy percent of the people I see are lighting up or already smoking. Now, maybe the rest of the country can faze out smoking, but there will always, ALWAYS be smokers in New York. (I'm a former smoker too.)
posted by miss-lapin at 5:08 PM on July 17, 2001

you know what... everyone knows that heroin is horrible for people, yet many still do it.

I'm not talking addicts here either, I'm talking new users. Let's face it, people will smoke.

And no I'm really not equating smoking=shooting horse. Just using the most extreme example I can think of.

And it's mainly because I started back up recently... damn it's tough to quit when most of the people you socialize with smoke
posted by tj at 6:49 PM on July 17, 2001

Lot of former smokers here... man I miss it some days, don't you? The bloated promise of a fresh full pack... stripping off the cellophane string (comes right off, not like those shitty ones on CDs)...kicking out a single on the side of your knuckle... pulling out your Zippo, cranking the lid back (clank!), smell of the lighter fluid, them spin the wheel and the tiniest of "whups"... the hint of crackle when the flame hits the end of the cigarette... the first inhale, it settles into your lungs like a warm fuzzy blanket of love, and the maybe five-second pause before you feel that little tiny "eeeeeeeeeeeee" of the nicotine cranking up your heartbeat and lifting the top of your skull up just a micrometer or so... then out with the first big chuff, a beautiful cloud of fragrant gunmetal smoke, capped off with a single, perfect smoke-ring that floats out like a hologram, then slowly, inexorably falls apart in every direction at once...leaning back in your chair, cigarette nestled at the first knuckle of your first and second fingers, hovering over a pristine cut glass ashtray that begs you to tap that first bit of cylindrical ash...
posted by UncleFes at 7:59 AM on July 18, 2001

everyone knows that heroin is horrible for people, yet many still do it.

Horribly addictive, yes. I read a study, though, that said in over time the negatie effects of heroin addiction - if you discount the aspects of addiction itself - were negligible (!)

The human body, apparently, so long as the addiction to heroin is fed properly (proper dosage and all that), goes to very little long-term physical detriment. The things that hurt heroin addicts are the phyical aspects of becoming addicted then continually fighting addiction (the addiction-withdrawal-readdiction roller coaster), (b) the lifestyle aspects of being addicted to an illegal, highly-priced drug (like becoming a criminal to support one's habit), and the effects of the chemicals used to cut the raw heroin before it goes to the addict.

Not sure that's *entirely* true, but I remember them making a good case. It wasn't in High Times or anything, either, something like JAMA.
posted by UncleFes at 8:08 AM on July 18, 2001

Fes, you are incorrect. Or more accurately, your statement may be factual, but it is wholly insufficient. Because while everything you said is probably true, there are some aspects of the experience you're missing.

Heroin causes explosive incontinence and vomiting. It also causes your body to stop producing dopamine properly. If you miss feeding your habit, you go into a kind of agony caused by those low dopamine levels, where your entire body starts sending your brain unimpeded pain signals and you convulse. When I say convulse, I mean body wracking tremors that can dislocate your joints and even break bones on occassion. I'm not even talking about the consequences to your health of being totally centered on a drug to the detriment of eating, sleeping, bathing or moving other than to procure it, which you covered in your statment. But even if you have a full supply of heroin and never have to worry about withdrawl, a drug that can make you incapable of getting any nutrition out of your food because it makes you throw up and then either constipates you or makes you violently incontinent is very, very bad for you.

I'm also forgetting the infections it can cause if you take it intravenously, but a lot of the addicts I know smoke it, so that's hardly universal.
posted by Ezrael at 10:07 AM on July 18, 2001

UncleFes: Wow! Your description was almost as good as the real thing! I wonder if we could parlay this into a "phone-smoke" biz, a la "phone sex!"

...I need a cigarette...
posted by davidmsc at 10:39 AM on July 18, 2001

Didn't know that Ez, thanks.

So (not having tried it, even as wonderful as the explosive incontinence sounds), what's the attraction? I mean, I can't see a bunch of model types, rock stars and half-assed artists sitting around vomiting - ok, maybe vomiting - but shitting themselves?? Dopamine or no dopamine, that ain't too cool.

It must feel DAMN good.

almost as good as the real thing!

But.... not.... quite :)
posted by UncleFes at 10:54 AM on July 18, 2001

Fes, I was trying to make the point that there is no way to keep people from smoking. ( I was not expecting this to turn in to a heroin discussion.. wow)

And after reading your virtual smoke.. well... umm... I gonna go have a real one (damn you're good look into a job at Phillip Morris).
posted by tj at 1:06 PM on July 18, 2001

Tj: I know, the thought just popped into my head about that study so I wrote it up. Just noodlin. I agree with you too - only one way to keep me from smoking: fear of spousal reprisal.

Thanks! People who've never smoked just don't understand the sheer physical pleasure of it, do they?
posted by UncleFes at 2:20 PM on July 18, 2001