Saturday, November 7, 2015

How the anti-smoking lobby keeps people smoking

Stigmatizing people won't win you their acceptance. Children looking to make friends understand this basic aspect of social dynamics, so do men on first dates, and so does almost everyone else. But there's one group that usually fails to understand that people are more likely to listen to you if they like you: the public health establishment.

According to a study released earlier this week, smokers are less likely to give up their habit when they're vilified for it:

Public health policies targeted at smokers may actually have the opposite effect for some people trying to quit ... stigmatizing smoking can, in some cases, make it harder for people to quit because they become angry and defensive and the negative messages lead to a drop in self-esteem.
This isn't new information, of course. The authors reviewed 30 studies related to the stigmatization of smokers, so the data is out there for anyone who wants to read it, including the people making public health policy. Why they would continue ostracizing smokers with public smoking bans, irritating billboards and graphic warning labels is anyone's guess, though health nannies aren't the most civil people around, and they have no problem ignoring evidence when necessary. Perhaps that explains their persistent yet ineffective harassing of smokers.

There's no need to dwell on these results much more, since they've been replicated dozens of times.Whether we're talking about fat people, heroin addicts or fundamentalist Christians, scorn won't motivate them to change their behaviors, or their beliefs in the last case. It's a lesson all busy bodies should meditate on before they go out crusading again.    

One interesting observation arises from this study, though. Perhaps the anti-tobacco lobby hasn't been all that effective over the decades. They would no doubt protest my speculation, proudly patting themselves on the back for reducing smoking in the process. But it's worth noting that most of their initiatives fail. Public smoking bans never yield the health benefits ascribed to them, and smoking cessation programs are generally ineffective, excluding e-cigarettes, which the public health establishment is eagerly trying to ban. Moreover, the massive amounts of taxpayer money dumped into tobacco control programs around the country seem to exert little influence on smoking habits.

These factoids are interesting on their own, but they're especially intriguing with this latest study in mind. Despite the billions of dollars spent on tobacco control, smokers persist in their habit because these stop-smoking campaigns are designed to shame and ostracize them out of smoking, which is simply ineffective.

The next push-back would be that smoking has declined drastically in the last 50 years, and surely we have the anti-smoking lobby to thank for this public health victory! Well, no, not really. Smoking has certainly declined, but the downward trend began just after the Surgeon General's report on smoking and health was released in 1964. That document launched the first wave of advertising bans, warning labels and government reports on the health effects of smoking, and sin taxes on tobacco have only increased since the 1960s. I humbly suggest that good evidence combined with stiff penalties have incentivized people to quit smoking, or to never start.

Stanton Glantz and his fellow public health warriors would surely also claim credit for these ever-increasing tobacco taxes, and on this point they actually deserve some recognition. But a caveat is in order: Congress didn't get the idea to tax cigarettes from The Campaign for Tobacco-Free Kids. The federal government has taxed tobacco for much of American history anyway, usually to finance wars. Moreover, convincing politicians to collect higher taxes isn't much of a challenge, especially when the industry you're attacking shoots itself in the foot and then gets in bed with you, in hopes of avoiding more lawsuits and even tighter regulations.

This could all change in hurry, however. The anti-smoking lobby could embrace harm reduction as a means of encouraging smokers to quit, stop publishing shoddy research and, of course, quit demonizing smoking. It's amazing what can be accomplished when you base policy on good science and stop telling people how terrible they are. We have an example of how this works as we slowly move toward sensible drug laws in the United States.

That last paragraph, sadly, is mostly fantasy. There are simply too many entrenched interests who would lose out if Big Public Health shifted its stance on smoking. Indeed there's a good case to be made that this puritanical approach to tobacco control is maintained by design, not despite its poor track record but because of it. Such an argument requires a level of cynicism that I don't possess. So I'll just end here with a  simple observation: whatever their motivations, public health advocates really suck at protecting the public from smoking, and they could fix that overnight if they actually wanted to.