Wednesday, May 25, 2011

So, am I sick, or just stupid?

The anti-smoking movement can't decide.

Via Michael Siegel:
"In a press release issued yesterday, Professor Banzhaf argues that: 'although there is evidence that for many people smoking involves addiction, that addiction is to the drug nicotine, not to the act of smoking itself, which is a behavior. Because those who desire to quit smoking (e.g., for a medical procedure) can ingest nicotine from nicotine gum, nicotine patches, nicotine spray, nicotine inhalers, and e-cigarettes, their decision to ingest it by smoking rather than by using nicotine replacement products is a choice. Since it is a choice rather than an addiction, disease, or health status, it seems more legally justified to restrict access to medical care to smokers than to the obese.'"
Compare that to this New York State Dept of Health sponsored website, talktoyourpatients.org, aimed at getting doctors to pressure their patients into quitting. It leans heavily on faux scientific language: quitting smoking becomes "tobacco cessation", occasional smoking is a "relapse"-- it even has a very impressive "pharmacotherapy chart" listing all the wonderful toxins you could be ingesting instead of nicotine, including your favorite psychotic-break-inducing pill and mine: Chantix (here's a fun story about that little wonder drug-- if anyone's curious, there are plenty more where that came from)! Hell, the ad I saw that brought me to the page in the first place was a banner on the New York Times website alternating between "SMOKING IS A DISEASE" and "TREAT IT".

Here the anti-tabagists find themselves torn between two currents in contemporary thought: the cult of healthism on the one hand, and the medicalization of vice on the other. 

The former holds that health, as the only ultimately real value, must be protected and venerated. This means that those who would reject physical health in favor of other pursuits are heretics--reckless, unconscionable sinners that must be reigned in, shamed, and, eventually, completely stopped. Thus are smokers cast out onto cold street corners in winter and denied well-ventilated bars in the summer, thus are we assumed to be terrible parents, thus are we banned from parks, thus are we discriminated against when we apply for jobs. Only such pseudo-religious fanaticism could lead people-- licensed medical professionals, no less-- to actually buy into preposterous bombast about the dangers of "third-hand smoke": 
"The doctor spent a sizable chunk of time trying to convince us that if my honey smoked at all, even outside, the smoke would magically migrate into the house and give our baby respiratory problems. When we expressed incredulity, she gave us this look of condescension and continued to try and extract some kind of guilty admission that he was trying to quit or at least he felt really bad. ... She tried to tell us that the smoke on his skin would give our son a debilitating disease, even though my husband washes his hands every time he comes back inside."
Such is the John Banzhaf school of puritanical nonsense. Such types have no interest in meaningful tobacco harm reduction or learning about the efficacy of smoking bans; theirs is a zero-tolerance perspective motivated not by science, but by dogma. These are the ones who'd like to ban smoking in privately owned homes.

The latter, seeking ever to escape the burdens of their own autonomy, chalk up every failing to some chemical imbalance or hereditary predisposition-- 'fault', also known as 'responsibility', is a dangerous and self-defeating notion that must be undermined and cooed away, often with the help of medication. Now these types aren't going to leave us to our own devices any more than the others, but you'd think they'd be more open to less dangerous tobacco products, or more curious about the relationship between, say, smoking bans and heart attacks. Sadly, the health cultists have dominated the conversation for so long that the autonomy-deniers have inherited much of the anti-scientific, absolutist approach.

I hope I don't have to point out how, despite being flatly contradictory, these two attitudes feed into and strengthen one another. I clearly have no respect for either, but, quite frankly, I'd rather be attacked than pitied.

1 comment:

  1. Tristyn,
    It depends on the day of the week. As I've learned, the anti-smoking advocates (i.e., my colleagues) will turn on a dime in order to support their agenda.
    Incidentally, I am a Yale Med grad. Hope you're enjoying New Haven.

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