April 1, 2019
by Naomi Lopez Bauman and Matt Miller
Most of us can agree that people have the right to undertake dangerous activities for purely recreational purposes. Some choose to base jump, free climb, and skydive—just because they enjoy the thrill. As risky as these activities might be, it would be absurd to restrict the use of safety measures such as helmets, wind gauges, or eye protection.
Smoking is also dangerous. But California lawmakers are now pushing a proposal that would eliminate safer alternatives to conventional, combustible cigarettes.
In California, it is already illegal to sell tobacco products to anyone under age 21. That is why it is so perplexing that, in response to concerns over teenage vaping, the California Senate has passed a proposal to ban the sale of all flavored tobacco products, including e-cigarettes and flavored smokeless tobacco, despite the fact that these products are far less harmful than cigarettes and play an important role in smoking cessation.
The dangers of conventional cigarettes are well established. Cigarettes deliver nicotine, an addictive chemical found in tobacco, as well as other toxins including tar and carbon monoxide, to the lungs. According to a report by the U.S. Surgeon General, “smoking causes 87 percent of lung cancer deaths, 32 percent of coronary heart disease deaths, and 79 percent of all cases of chronic obstructive pulmonary disease (COPD).” Also, smoking is responsible for every third cancer death and is believed to contribute to cancer treatment failure.
While e-cigarettes typically contain nicotine and do produce some toxins (albeit at much lower level levels than conventional cigarettes), they do not produce the most harmful components of conventional tobacco smoke: tar and carbon monoxide. While no one should consider e-cigarettes as “safe,” Public Health England, the country’s public health agency, has concluded that “e-cigarettes are 95% less harmful to your health than normal cigarettes, and when supported by a smoking cessation service, help most smokers to quit tobacco altogether.”
Similarly, smokeless tobacco products also offer an important alternative for smokers. The federal government’s own data shows that for cigarette smokers, switching from cigarettes to smokeless tobacco products reduces lung cancer risk and mortality.
The current California proposal to eliminate these far less harmful options to conventional cigarettes comes at a time when smoking-related disease and death is an increasing concern for the federal-state Medicaid program. Medi-Cal now accounts for more than one-third of the total state budget (when counting federal and state funding).
According to a 2018 study examining the impact of smoking on Medi-Cal, “in California, smoking-related Medicaid healthcare spending is estimated at $3.58 billion annually. Putting this into perspective, this cost exceeded the California Department of Public Health’s (CDPH) fiscal year 2017/2018 $3.2-billion budget.” In fact, the study reveals that smokers in the state’s Medi-Cal program account for more than 40 percent of the state’s total smokers.
According to the Centers for Disease Control and Prevention (CDC), 40,000 Californians are dying from smoking-related deaths every year. Yet the state legislature now wants to take away an alternative that is proven to be far safer than conventional cigarettes. This makes about as much sense as banning seatbelts in cars in hopes that people will drive slower.
In addition to the data—which clearly support vaping as an alternative to conventional cigarettes—the principle of individual autonomy should also not be forgotten. If a harmful product is legal to use, consumers should always have the option of using less harmful alternatives. This is not only consistent with public health goals of harm reduction and the principles of individual autonomy and liberty; it is also consistent with taxpayer interests and public health.