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Exploring the debate on tobacco victims

D. John Doyle

Cleveland Clinic Abu Dhabi

E-mail : bhuvaneswari.bibleraaj@uhsm.nhs.uk

DOI: 10.15761/LBJ.1000112

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According to the World Health Organization “the tobacco epidemic is one of the biggest public health threats the world has ever faced, killing more than 7 million people a year” [1].  Jha et al. note that on a world-wide basis “tobacco use is estimated to kill about 5 million people annually, accounting for 1 in every 5 male deaths and 1 in 20 female deaths of those over age 30” and that based on existing smoking rates “annual tobacco deaths will rise to 10 million by 2030” [2].

As of 2015 only about 17% of Americans smoke [3], yet everyone pays for the cost of treating tobacco-related illnesses via higher insurance premiums and taxes. Many people argue that it is not fair that non-smokers have to pay many billions of dollars in health insurance premiums and taxes for the medical treatment of smokers. Given the well-established link between long-term tobacco use and lung cancer, this has lead some individuals to suggest that life-long smokers in America should be denied Medicare or Medicaid health insurance coverage for the treatment of lung cancer.

However, I would suggest that such a policy is both impractical and unethical. Let me explain.

First, while there is no doubt that health care costs are higher for smokers, the extra health care costs to Medicare and Medicaid associated with smoking can be recovered simply by increasing the price of cigarettes. This would be a particularly effective alternative to denying Medicare services to smokers, since there is strong data to suggest that raising the cost of cigarettes is one of the most effective ways of reducing consumption.

Secondly, tobacco smoking is hardly the only form of self-destructive behavior. Other self-destructive practices that one might focus on include the following:

  • excessive alcohol consumption
  • not wearing seatbelts while driving
  • participation in unsafe sexual practices
  • excessive food consumption leading to morbid obesity
  • use of dangerous recreational drugs such as cocaine or heroin
  • participation in dangerous sports without sufficient attention to safety issues

In the interests of fairness, if one were to deny Medicare services to smokers, it would also be necessary to deny Medicare services to individuals who sustain clinical insults because of self-destructive behavior. It should be apparent that this would be a logistical nightmare.

Third, if life-long smokers on Medicare health insurance should be denied coverage for the treatment of lung cancer, they should also be denied coverage for other diseases strongly linked to smoking: coronary heart disease, cerebrovascular disease, peripheral vascular disease, emphysema, chronic obstructive pulmonary disease, bladder cancer, and even age-related macular degeneration (AMD), a leading cause of blindness.

Fourth, the US government has not made a concerted effort to reduce tobacco use. Industry commentators often point out that there is an incestuous relationship between the tobacco industry and US government. While the idea of regulating tobacco use and creating a "smoke-free" society remains a popular dream in Washington, the reality is that the federal government and the 50 states eagerly consume a steady flow of sin taxes generated by the sale and consumption of tobacco products. Furthermore, most amazingly, Washington continues to subsidize the growth of tobacco. I would suggest that the federal government should clean up its own house first before implementing draconian Medicare policies of the nature suggested.

Fifth, there are many causes of lung cancer besides tobacco smoking, and some forms of lung cancer (e.g. small cell cancer) are not related to smoking at all. Radon exposure, exposure to asbestos, and even dietary factors may account for many cases of lung cancer. In fact, the only form of lung cancer that is unequivocally linked to smoking is squamous cell carcinoma.

Finally, medicine has a humane tradition of being nonjudgmental and caring for all regardless of social worth or social standing. Public policy should reflect this. I would suggest that setting into place a policy whereby a life-long smoker's access to Medicare for the treatment of lung cancer should be forfeited is inhumane in the extreme. Such action says to the patient that he or she is unworthy of our clinical attention, and is in clear violation of the principle of beneficence. 

References

  1. World Health Organization. Tobacco.  WHO Fact Sheet No 339. May 2017.
    http://www.who.int/mediacentre/factsheets/fs339/en/
  2. Jha P, Chaloupka FJ, Moore J, et al. Tobacco Addiction. In: Jamison DT, Breman JG, Measham AR, Mariam Claeson, David B Evans, et al. (2006) Disease Control Priorities in Developing Countries. 2nd edition. Washington (DC): The International Bank for Reconstruction and Development / The World Bank, Chapter 46. [Crossref]
  3. Current Cigarette Smoking Among Adults — United States, 2005–2014.  Morbidity and Mortality Weekly-Report(MMWR).November13,2015/64;1233-1240. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6444a2.htm

Article Type

Editorial

Publication history

Received date: July 18, 2017
Accepted date: August 21, 2017
Published date: August 23, 2017

Copyright

© 2017 Doyle DJ. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Citation

Doyle DJ (2017) Exploring the debate on tobacco victims. Lung Breath J 1: DOI: 10.15761/LBJ.1000112

Corresponding author

D. John Doyle

Cleveland Clinic Abu Dhabi

E-mail : bhuvaneswari.bibleraaj@uhsm.nhs.uk

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