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A License to Smoke?

"Anybody got a match?"
That was the first line uttered by Lauren Bacall in her storied Hollywood career, spoken in an early scene of the war-romance To Have and Have Not. The sleek, sultry actress needed a light for her cigarette. Humphrey Bogart acquiesced to Bacall's request, tossing her a small box of matches. She caught it with blasé indifference. Mystery shone in her eyes as she kindled the match and the flame flared. The allure with which she lit her cigarette and took a puff was almost dizzying to moviegoers (the males, at least). It was not smoke that she exhaled, but sheer sexiness.

The way that smoking is viewed in society has certainly changed a lot since the days when Bacall and Bogart lit up the silver screen. We now understand that the habit leads to lung cancer, emphysema, and heart disease, health conditions that are aren't remotely sexy. Today, smoking is oft viewed with contempt, and the act is banned from bars, restaurants, and public places across the United States. Additionally, cigarettes are wantonly taxed, and tobacco companies are virtually disallowed from advertising their products.

But the current policies don't go far enough, says Simon Chapman, a professor of public health at the University of Sydney. In a paper appearing as a part of a PLoS Medicine Debate, Chapman makes a persuasive case for a "smoker's license" - a smart swipecard that would be required to purchase cigarettes from a tobacco retailer.

Chapman prefaces his policy explanation by noting that many life-saving pharmaceuticals currently require doctors' prescriptions, which are basically just temporary licenses. It's hypocritical, he says, that tobacco products -- which present far more danger to public health, are sold almost everywhere, and are easily purchased by underage teens -- are not subject to the same rigorous stipulation.

The key points of Chapman's plan are outlined below (click here to seem them all):

  1. License Card - All smokers would be required to obtain a swipecard to purchase cigarettes. Applications would be made widely available. There would be a yearly license fee ranging from approximately $100 to $200. Smokers would have to renew their license annually.
  2. Purchase Limits - Smokers would be able to set limits to the amount of cigarettes they can purchase per week, ranging from 70 to 350. The higher the limit, the more they must pay in license fees. Smokers could adjust their limits at any time.
  3. Incentive to Surrender License - If a smoker quits his or her habit before age forty, he or she would be able to surrender their license and be refunded all license fees paid during their licensing period. The smoker would not be allowed to reapply for a license.
  4. New Smoker's Test - An 18-year-old wishing to obtain a smoking license must first pass a test on the health risks of tobacco use.

Chapman admits that his plan may seem radical now, but he insists that it's no more radical that the current smoking laws and restrictions which are now commonplace.

He also acknowledges that a smoking license comes with a few potential concerns, including administration costs, smoker stigmatization, infringement of rights, and the potential to create a black market. But he believes that the benefits of the plan far outweigh the costs, especially when you consider that upwards of $96 billion is spent on smoking-related healthcare costs in the United States each year.

"The requirement for a license would send a powerful, symbolic message to all smokers and potential smokers that tobacco is no ordinary commodity, akin to grocery items, confectionary, or any product on unrestricted sale," Chapman asserts.

The Case Against

Jeff Collin, the director of the Global Public Health Unite at the University of Edinburgh in Scotland agrees that tobacco consumption needs to be reduced, but disagrees with the idea of a smoking license. He contends that such a law would "inevitably be widely perceived as demeaning, onerous, and punitive" against smokers.

Collin also cites legendary British philosopher John Stuart Mill, who said, "(t)he only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others." Under this reasoned definition, laws that ban smoking in public places are legitimate. But a smoking license merely restricts individual consumption, so it certainly oversteps Mill's boundary of responsible lawmaking.

The smoking license: a boon for public health and the economy, or a degradation of personal rights? What do you think?

Source: Chapman S (2012) The Case for a Smoker's License. PLoS Med 9(11): e1001342. doi:10.1371/journal.pmed.1001342

Source: Collin J (2012) The Case against a Smoker's License. PLoS Med 9(11): e1001343. doi:10.1371/journal.pmed.1001343