The scientific justification for the ban on Smoking

In a recent article for Slate, Jacob hawk (Jacob Grier) proves that the scientific justification for a broad ban on Smoking in public places was flawed. According to James, the recent, more robust study demonstrated the lack of many significant benefit from these laws for the health of the population. Although the opinion of Jacob in regard to used scientific evidence, not unreasonable, I think that he is doing on the basis of the criticism of this evidence is too far-reaching opposite conclusions.


Passive Smoking


At the moment most of the evidence collected indicates the presence associated with passive Smoking health risks, which, however, is statistically small. This discussion revolves around the significance caused by passive Smoking harm, and few doubt that such harm is. These harmful effects include heart attack, lung cancer, stroke and asthma exacerbations. The scale of the population, even small risks lead to a significant number of additional deaths and negative changes in health status. Evaluation CDC (Centers for Disease Control and Prevention — approx. TRANS.), for example, exposure to passive Smoking annually causes 34000 additional deaths caused by heart problems.


The increased recognition of the threat of passive Smoking to health has given greater political weight to the efforts of the fighters against Smoking, bringing in the last 30 years to the cultural shift. As a result, Smoking was banned in most enclosed public and a significant part of jobs.

Objective question on which he focused, as influenced by these prohibitions on changes in the health status of the population. He is a thorough analysis of the relevant literature, although, in my opinion, his interpretation of this literature is biased in favor of the claim that he is trying to prove. Based on this analysis he concludes that the use of prohibitions was overvalued, and, perhaps, these gains were not at all.


Suspicious lack in his survey of references to Cochrane systematic review 2016, which is the gold standard for systematic reviews in evidence-based medicine. This updated in 2016, the review comes to the following conclusion:


“Since the publication of the first version of this review, the existing evidence reinforces the previous conclusion that the introduction of a legislative Smoking ban has indeed led to positive changes in the health status of the population, due to less recent exposure to passive Smoking. The best proof of this is the reduction in the number of diagnoses of acute coronary syndrome. There is evidence of decreased mortality due to Smoking-related diseases at the national level. There is incomplete evidence of the impact of bans on respiratory and perinatal changes in health status, and the prevalence of Smoking and tobacco use.”


Another Cochrane review from 2016 suggests that Smoking bans have led to the reduction of tobacco consumption and exposure to passive Smoking in medical institutions and universities, but not in prisons.


A systematic review of 2017 comes to the conclusion that bans on Smoking in public places does not increase Smoking at home and really cause a General reduction in Smoking.


Browse 2016 devoted to children’s health, also found positive results:


“There is growing evidence that the positive health effects of bans on Smoking applies to children. In addition to protecting children from tobacco smoke in public places, the relationship between the prohibition on Smoking and the improved health status of children can be caused by a decrease in Smoking during pregnancy and less exposure to tobacco in the home environment. Recent studies have demonstrated that the adoption of a legislative ban on Smoking was associated with a significant reduction in the number of perinatal deaths, premature births and trips to the hospital with respiratory infections and asthma among children, although such positive results were not obtained in all studies”.


This is the most recent reviews that I was able to find, and, in my opinion, they truly reflect the results of the study. Hrayr is in General a different assessment of research results, focusing on the fact that the assessment of the impact of taboos has declined with more rigorous and extensive research.

However, this should not surprise anyone. In fact, the study of the effects of the Smoking ban is a Prime example of the General direction in research, which I often discuss here. Preliminary studies have demonstrated a huge bias in favor of positive results, partly reflecting the bias of the researchers, partly — bias publicists. As a follow-up study is carried out more strictly and carefully, the scale of the results is usually reduced (this is called lowering effect). This effect is fairly constant, but may raise suspicion that it is presented in isolation from the General context and in connection with some specific topic.


Hrair believes that the positive effects of bans decrease to almost zero, but I don’t think the most recent systematic reviews confirm this conclusion. The positive results initially presented (such as, for example, as shestidesyatiletie decrease in the number of heart attacks) was incredibly large, however, this should not set a benchmark for further comparisons. We should evaluate the positive results of research in an independent manner.


As we discussed measures to protect the health of society, we must consider the decrease in negative changes in the health status of the population, and surveys show that this reduction really is, which is significant. Enough of it to justify the current bans (or even expand)? It is a question of the philosophy of ethics, which can be based on scientific data, but also requires value judgments.


The ethical side of things


Hrair — libertarian, recognizing the following:


“Nearly a decade ago, I worked at the Cato Institute at the time when he received donations from tobacco campaigns. In addition, during his career as a bartender, I was mixing cocktails for the event in 2016, organized the Diamond Crown. The work was unpaid, but in return, I received a humidor and a cigar”.


Think of it as you want. It’s not so much a criticism, as the indication of the fact that he holds a certain point of view in terms of the values that it can assume the most important (for example, the importance of personal freedom).


I am a doctor and openly admit that I proceed from a different point of view. For me Smoking is the enemy, and we must do everything possible to reduce its spread. I openly admit that I can’t stand passive Smoking and consider it a violation of my own personal freedom.


When evaluating the ethics of Smoking, we must consider the cultural and historical context. Smoking tobacco is permitted due to the long history of its use. Imagine what would happen if Smoking was invented just now, and try some company to introduce it to the market. The use of the discussed product is obvious harm. This product increases the risk of lung cancer, heart disease, heart attacks and respiratory diseases. The same risks, albeit to a lesser degree, it increases to affected outsiders. This product is also addictive, which undermines the free will of the person using it. The use of this product does not have any positive effects — it is used in purely entertainment purposes.


I think it would be reasonable to conclude that this product, try some company to put it into use today never would have passed the specified limits and would not be legalized. In fact, tobacco — a legacy of the past which we tolerate only because of its long history.


In fact, it is quite reasonable to ban all use of tobacco as harmful and causing the addictive product. Against such a ban, there are two arguments. The first is that people have the right to make decisions of this kind. The second relates to the practical consequences of the ban, which will only lead to the emergence of a black market, and many of the costs of enforcement.


This is a reasonable argument, but it is worth considering the effects of Smoking to society. In addition, there is already a precedent for many laws protecting citizens from their own mistakes — for example, requiring them to wear seat belts while driving or wear a helmet. The price of other people’s mistakes, we pay for collectively covering the costs of their treatment.


All of this must be weighed in comparison with the damage that will cause the prohibition of individual freedoms. The transformation of the state into annoying nanny also has its unintended evil consequences.

© RIA Novosti, Igor Zarembo | go to fotobanka cigarettes with pictures, warning about the dangers of Smoking

To clarify my position: I do not achieve a complete ban, because they do not consider it acceptable in our culture, and I do not think it practical. In able-bodied adult should have a reasonable right to endanger yourself so far as he is properly aware of the consequences and does not harm others. However, he should be willing to pay the price for such action — for example, increased contributions for health insurance.


In addition to a complete ban, there are a number of reasonable restrictions, which can mitigate the harmful effects of Smoking to health. In addition, among students of ethics thinkers assumed that negative rights outweigh positive. Other things being equal, human right “And” to respect him, something was not done, outweighs the right of a person “B” to to do something.


In my opinion, this means that the human right not to be exposed to tobacco outweighs someone’s right to smoke. No one should have to breathe tobacco only because he wants to make the flight, eat in a public restaurant or to be in the workplace. If you have decided to engage in unhealthy entertainment, it is your responsibility to ensure that this choice was not imposed on others.


He complains that smokers suffer from an increasing social stigma. I would say that the stigma is exposed to Smoking, but not smokers themselves. In any case it’s good: although in our society and is not prohibited voluntary unhealthy behavior, we can still establish its fallacy and to show their disapproval. For decades Smoking was reported in a positive light and presented a lesson for the bright and interesting people. This has now changed, and Smoking is seen as a weakness. It’s good, and it would be quite reasonable to argue that such a reversal is fair compensation for prior dishonest advertising.


He recognizes that the ban on public Smoking has become a part of our culture and, most likely, can go away. That’s good. Now that non-smokers used to live without having to breathe someone else’s smoke, return everything as before will be difficult. I view this as a correction to the unfair place of Smoking in the culture of the past. Smoking is too long get too big concessions just because it was part of the culture of our society.


Consider one more thing — about 70% of smokers want to quit. It suggests a degree of habituation to tobacco. If they want to quit, it is difficult to condemn the laws that can help them to do that or at least reduce the amount they smoked. In this regard, even what we have done, is not enough.