U.S. President Barack Obama's doctor confirmed last month that the President no longer smokes. At the urging of his wife, Michelle Obama, the President first resolved to stop smoking in 2006, and has used nicotine replacement therapy to help him. If it took Mr. Obama, a man strong-willed enough to aspire to and achieve the U.S. presidency, five years to kick the habit, it is not surprising that hundreds of millions of smokers find themselves unable to quit.
Although smoking has fallen sharply in the U.S., from about 40 per cent of the population in 1970 to just 20 per cent today, the proportion of smokers stopped dropping around 2004. There are still 46 million American adult smokers, and smoking kills about 443,000 Americans each year. Worldwide, the number of cigarettes sold – six trillion a year, enough to reach the sun and back – is at an all-time high. Six million people die each year from smoking – more than from AIDS, malaria, and traffic accidents combined. Of the 1.3 billion Chinese, more than one in 10 will die from smoking.
Earlier this month, the U.S. Food and Drug Administration announced that it would spend $600-million over five years to educate the American public about the dangers of tobacco use. But Robert Proctor, an historian of science at Stanford University and author of the forthcoming Golden Holocaust: Origins of the Cigarette Catastrophe and the Case for Abolition, argues that to use education as one's only weapon against a highly addictive and often lethal drug is unpardonably insufficient.
"Tobacco control policy," Mr. Proctor says, "too often centres on educating the public, when it should be focused on fixing or eliminating the product." He points out that we don't just educate parents to keep toys painted with lead-based paints away from their children's mouths; we ban the use of lead-based paint. Similarly, when thalidomide was found to cause major birth defects, we did not just educate women to avoid using the drug when pregnant.
Instead, Mr. Proctor has called for regulators to do two things. First, because cigarettes are designed to create and maintain addiction, the amount of nicotine should be limited to a level at which they would cease to be addictive. Smokers who want to quit would then find it easier to do so.
Second, that we should bear history in mind. The first smokers did not inhale tobacco smoke; that became possible only in the 19th century, when a new way of curing tobacco made the smoke less alkaline. Regulators, therefore, should require that cigarette smoke be more alkaline, which would make it less easily inhaled, and so make it harder for cigarette smoke to reach the lungs.
As Mr. Proctor says, cigarettes, not guns or bombs, are the deadliest artifacts in the history of civilization. If we want to save lives and improve health, nothing else that is readily achievable would be as effective as an international ban on the sale of cigarettes. (Eliminating extreme poverty worldwide is about the only strategy that might save more lives, but it would be far more difficult to accomplish.)
For those who recognize the state's right to ban recreational drugs such as marijuana and ecstasy, a ban on cigarettes should be easy to accept. Tobacco kills far more people than these drugs.
Some argue that as long as a drug harms only those who choose to use it, the state should let individuals make their own decisions, limiting its role to ensuring that users are informed of the risks that they are running. But tobacco is not such a drug, given the dangers posed by secondhand smoke, especially when adults smoke in a home with young children.
Even setting aside the harm that smokers inflict on nonsmokers, the free-to-choose argument is unconvincing with a drug as highly addictive as tobacco, and it becomes even more dubious when we consider that most smokers take up the habit as teenagers and later want to quit. Reducing the amount of nicotine in cigarette smoke to a level that was not addictive might meet this objection.
The other argument for the status quo is that a ban on tobacco might result in the same kind of fiasco as occurred during Prohibition in the U.S. That is, like the effort to ban alcohol, prohibiting the sale of tobacco would funnel billions of dollars into organized crime and fuel corruption in law-enforcement agencies, while doing little to reduce smoking.
But that may well be a false comparison. After all, many smokers would actually like to see cigarettes banned because, like Mr. Obama, they want to quit.
Peter Singer is a professor of bioethics at Princeton University and laureate professor at the University of Melbourne.