Tag Archives: FCTC

World No Tobacco Day 2011

World No Tobacco Day is soon upon us and I thought it might be useful to translate the original press release to reflect the real world implications of the FCTC treaty.

Some of us will be following this up with a blog post or two on how this treaty helps to maintain high levels of smoking-related disease. We do have a bit of a soft spot for this particular date since we launched our website, TobaccoHarmReduction.org on this day five years ago specifically to respond to WHO’s statement/position that all tobacco was equally harmful. In fact, locally we got more press on that day than WHO did for that year’s No Tobacco Day. (Assuming that they ever learned to swim in the first place, could they already have been jumping the shark?)


The WHO Framework Convention on Tobacco Control (WHO FCTC) is the world’s foremost tobacco control instrument (hammer). The first treaty ever negotiated under the auspices of WHO, it represents signal achievements in the suppression of harm reduction and also in the oppression of all nicotine users regardless of whether or not such use has health consequences. In force since 2005, it is already one of the most rapidly and widely embraced treaties in the history of the United Nations, with more than 170 Parties. An evidence-unencumbered treaty, it reaffirms the right to restrict all nicotine users to only the most dangerous form of delivery and provides new legal tools to strengthen abstinence-only policies and wage a war on tobacco.

World No Tobacco Day 2011 will be designed to highlight the treaty’s overall self-importance, to stress signatories’ obligations under the treaty and to promote the essential role of the FCTC and WHO in demanding that countries meet those obligations.

Countries will be expected to obey the WHO FCTC as much as, if not more, than it did in 1996 when a resolution calling for this treaty was first adopted. Preventing tobacco use is the priority of this treaty. This year, thanks in part to FCTC efforts in obstructing access to safer alternatives, more than 5 million people will die from a smoking-related heart attack, stroke, cancer, lung ailment or other disease. That does not include the more than 600,000 people – more than a quarter of them children – who we will claim will die from exposure to second-hand smoke (according to the studies we prefer to accept).

As with any other treaty, the WHO FCTC confers legal obligations on its Parties – that is, on the countries (and the European Union) that have formally acceded to it.

Among these obligations are those to:
• Prevent public health policies from embracing harm reduction options.
• Adopt price and tax measures to strengthen the black market.
• Foster intolerance to even negligible exposure to tobacco smoke.
• Prevent safer (smokeless) tobacco products from being promoted as any more appealing than cigarettes.
• Work to eliminate any additives or processes that make any form of tobacco use pleasurable.
• Prevent any packaging information describing one tobacco product as safer than another.
• Nag people about the dangers of tobacco use.
• Promote and subsidize pharmaceutical products to smokers.
• Complain about the illicit trade in tobacco products created by our other actions.
• Ban sales (that are already banned) to and by minors.
• Pretend to support economically viable alternatives to tobacco
• Ignore that for in some economies tobacco is the most viable crop.

The treaty also recognizes the importance of international coercion in forcing low- and middle-income countries to meet their treaty obligations. The campaign will focus on the following key message: that countries must fully implement the treaty even if most of the early mortality in those countries has other causes and even if implementing this treaty will deplete funding initiatives addressing those concerns.

Other key messages will include:
• The treaty embodies the desire and commitment of many anti-tobacco organizations and thousands of activists to have a tobacco- and tolerance-free world.
• Individuals should encourage and help their governments in their own oppression.
• The treaty should be duly appreciated by institutions and individuals alike as a landmark in the history of demonizing a plant and drug rather than addressing the variable health consequences of the delivery methods.
• WHO and the FCTC stand ready to browbeat countries into meeting their obligations under the treaty and its related guidelines.

The treaty has already proved its efficacy in political posturing and selling the concept of prohibition to the general public. In itself a success, this treaty has already formed a template and inspiration to globally address other public health issues such as alcohol consumption and inexpensive convenience foods. Nevertheless, more must be done for the treaty to reach its full potential. At their recent meeting in Uruguay, the Conference of the Parties urged all countries to progress beyond outmoded conceptualizations of public health and individual welfare and to adopt its guidelines instead. Furthermore, they reaffirmed their commitment to prioritize the implementation of intolerance designed to control and demonize non-pharmaceutical nicotine consumption.

On World No Tobacco Day 2011, and throughout the following year, WHO will urge countries to put the treaty at the heart of their efforts to control the global spread of effective harm reduction and the threat of low risk nicotine consumption.

By bowing to WHO’s call, countries will enhance their ability to significantly reduce any harm reduction efforts, maintain the high burden of smoking-related diseases and deaths to keep the FCTC viable, and to remove the possibility of safe nicotine consumption.


Letting Africa take the hit

Recent WHO-FCTC declarations regarding restricting tobacco flavorings (and other additives) have raised considerable concern in the African burley growing countries (burley tobacco tends to be processed with additives). Their justification in their own words is

One major cause for concern is flavourings and additives being widely used in cigarettes and other tobacco products to increase their palatability and attractiveness – particularly among young people.

Though no one supports the creation of unwilling users, there is certainly some concern about deliberately making a legal pastime enjoyed by millions less enjoyable. Though this is business as usual when it comes to the treatment of tobacco users, there really is no precedent in any other area of consumption.

There is also no evidence that this will do anything other than reduce the enjoyment of smoking. Surveys have shown that kids do not usually start with flavored products (they start with whatever is at hand). At some level of engagement, people are pretty resilient. (Even very particular coffee drinkers will settle for substandard products rather than forgo their drink and most people knowingly eat sub-par food quite regularly.) Smokers who do not have their brand available will usually buy another; at the extreme smokers in prison have been known to roll up patches and smoke them. So all flavor restrictions are likely to do is make tobacco users (because this will affect smokeless tobacco users too) less happy.

Outside of tobacco control, that is known as sadism.

But let’s say just for a minute that the evidence is all wrong and this could really change the world and fewer people would smoke. Given that the developed world is most attuned to quality products, one would expect the greatest drops there. (As a rule, the more money you make and education you have, the less likely you are to smoke and if you do smoke, the more likely you are to quit.) So you have a “reasonable” justification that fewer people will smoke as a result.

And let’s say that this destroys the market for burley tobacco. That is, it is no longer a viable crop for African farmers. Though the FCTC and anti-smoking NGOs suggest they should just take up alternative crops the problem here is that while they are globally competitive in burley, they would be at a disadvantage with any other crop, not to mention that given the characteristics of the soil, only certain crops will grow there in the first place. (Tobacco is a plant that flourishes under conditions where many other plants do not.)

And would the FCTC even dare to proceed in this fashion if this were a developed world industry (this smacks of global paternalism in the worst way). Consider that in Malawi (just one of the nations that would be affected) that burley production comprises 60% of its export revenue and a full 13% of its economy.

Removing (or adjusting to) that portion of the economy of even a strong nation would be momentous but in the case of Malawi where 70% of the nation are already below the poverty line, and where the unemployment rate is a staggering 95% the results of this would be catastrophic.

Even if a burley ban is only a worst case scenario, it is a threat to a country that already is a worst case scenario.

And it seems somewhat immoral to scrabble to add a few more years onto the already long Western average lifespan at the expense of Malawi where the lifespan is under 50. The greatest threat to health is being poor so we could expect a trade here which would result in an even lower average.

What everyone seems to forget in this whole rush to eliminate smoking related disease is that it is actually a sign of great success when smoking related causes lead. What it means is that you have removed high infant mortality, diarrhea, diptheria, cholera, typhoid, and malaria; it means that you are living longer than 50 when most of these luxury conditions kick in.

So as a result of us beating those horrible conditions Malawi is still prey to, we will ask them to bite the bullet so that we can outlive them by even more than the 24 years we already do.

– Paul L. Bergen

FCTC: Constructing a new assault on smokeless tobacco and electronic cigarettes: Part 4: or taxing the way to prohibition

This the fourth of a series on this latest development at the FCTC. See Part1: Background, Part2, and Part3

This is the last worrying of this sad, and sadly influential, document.

This document which lists off various risks of the use of smokeless tobacco (ST) without differentiation among types, does so, only to make an argument for elimination of use and not for elimination of those risks. It is not that subtle a distinction but the former does not take users into account and the latter does.

When benign authorities address risky behaviors that many people like to engage in, and knowing that many of them will continue those behaviors even in full awareness of the health risks, they usually evolve strategies that will encourage users to reduce those risks (often through education or through developing safer satisfying variants) rather than attempting the impossible goal of eliminating the behavior itself.

The use of illicit drugs serves as a good example of persistent adherence despite great costs. Using heroin not only has a risk of overdose but of incarceration, periods of great vulnerability, financial burden, stigma and in general social dislocation. If heroin use is so difficult to eradicate, what hope is there for a drug (nicotine) that while having an effect does not incapacitate, can improve performance, and has health risks that tend to only arise after years of use (if they do at all). (And the public health response to an illegal activity thankfully and rationally has been to embrace safe practice education, needle exchanges, and providing a safer alternative (methadone), and ironically this has been accepted by many more than support a similar approach to legal tobacco).

As much as we might debate the precise magnitude of the effects of smoking, there is no doubt that there is an associated substantial risk; this is not certain about ST, and whatever risks there are are certainly less than smoking. In the context of harm reduction, it is not so much how risky ST is but that it can serve as a satisfying substitute for smokers. However, if human behavior is any guide, awareness of health risk differences is not always enough. If a smoker is financially strapped that may be enough to move them to another form of nicotine. Which brings us to the following excerpt from page 4:

“One of the major challenges in regulating smokeless tobacco products is their low cost. This is one reason such products are accessible to youth. Uniform taxation policy on all tobacco products, so as to discourage shifts to cheaper tobacco products”

My comments are in respect to Western more than non-Western product where we are quite certain of the comparative risk differences and while the FCTC document does not make that differentiation, it is that very willful dismissal that helps introduce a coercive global policy that threatens demonstrably safer products and the hope of establishing popular and safer alternatives to smoking.

Recently, in America there have been calls to increase the taxes on ST in some jurisdictions (calling it a loophole) and while many are argued as a source for needed revenue for strapped state budgets, the original reason given for tax hikes on tobacco was to pay for the increased burden of smoking on the health system. (This burden is disputed but that is not the issue here).

If the reason for taxation is to pay for health costs then safer products should be taxed less. Not only does it makes sense that product variations with fewer externalities should be cheaper but it may nudge nicotine users toward safer choices even if they are unaware of the risk differences.

What the Convention Secretariat is doing is eliminating any consumer choice among products based on price. Since, all other factors being equal, people will prefer what they already do, this would maroon many smokers who otherwise might switch. (It would also contradict their concern about tobacco use taking up too much of a family budget).

Eliminating price differences among tobacco products is a strong first step toward prohibition. Keeping smokers smoking by discouraging any reasons to try alternatives means the disease burden remains high, and will build popular approval for an outright ban on all products (no doubt including e-cigarettes).

The bottom line is that this organization has no regard for the health or welfare of nicotine users of any kind. They will willingly sacrifice millions of lives to service their desire for tobacco prohibition.

-Paul L. Bergen

FCTC: Constructing a new assault on smokeless tobacco and electronic cigarettes: Part 3: or disregarding the context of tobacco use

This the third of a series on this latest development at the FCTC. See Part1: Background and Part2.

In the Convention Secretariat report concern is expressed over the welfare of the disadvantaged but a disparagement of cheap sources of nicotine that would soften their plight.

First a little context on how much of a threat smokeless tobacco (ST) actually is in the 3rd world. Research on these types is limited compared to that on Western forms of ST and among the questions remaining are what aspect of this use is the most harmful part of it; there are suggestions that the source of the harm may lie in the other substances that are combined with the tobacco rather than from the tobacco itself. But for the sake of argument let’s accept that these are relatively risky products.

One of the arguments for employing ST in harm reduction in the West is that not only is it so much less risky than smoking but that the absolute risk of using it falls below many more common activities. Non-Western ST which varies much more in risk (different product combinations, manufacturing conditions, less product reliability) might be considered unreasonably risky to allow in the overall quite safe Western sphere. However in respect to the contexts within which they occur, these products no longer qualify as unreasonable risks.

They are still risky but when you live in the Sudan there are more important things to worry about (like war after war, and access to clean water which only a little over half have). Of course, trying to prevent a harm is not wrong just because there are more pressing concerns. But there will always be competition for resources and money spent trying to suppress something that makes hardly a dent in that nation’s public health will not then go toward things that could.

The Secretariat seems to like the same logic when they write (on page 7):

“The consumption of smokeless tobacco also has adverse socioeconomic consequences. In many low- and lower-middle-income countries scarce family resources are spent on tobacco products instead of food or other essential needs.”

There is no argument that money that could have gone to these other needs are spent on tobacco products. However, this argument is always made by people who have never had to make those choices.

The worse your living conditions become the more important any distraction from it becomes. For most of us, we seek distraction because we are bored and not because life is difficult. Even our definitions of what is difficult are absurd when compared with what most people on the globe experience on a daily basis.

Finally, tobacco use cannot be constructed as simply an issue of someone using a harmful product. As said, a simple distraction from boredom becomes something else under dire conditions. There are times when nicotine might add more to overall welfare than some food.

(Just one proviso to this argument: though I believe that an adult has the right to decide between food and nicotine, in some cases adults, and typically the man, jeopardize the family food for their own desire. I am not arguing for that. And yet there may be circumstances where using tobacco gives the breadwinner just enough respite to remain a breadwinner and not abandon hope entirely. These are not simple questions and have no easy answers which bears on the issue as a whole when organizations like the FCTC simply work toward bans without realizing that someone always ends up paying a price.)

Addendum: I neglected to tie this up in regards to how it affects tobacco harm reduction. Basically, the more essential nicotine use is to an individual, the more likely harm reduction will be more effective than a ban. The higher the socioeconomic status the more successful (and therefore the easier) quitting is. Bans work better when the targets have access to alternative pleasures; if it is your only pleasure, you will try to work around the ban. This also means that bans or severe restrictions on a global scale would end up having a disproportionate effect and that the health disparity between rich and poor (both in regards to people and nations) would be greater than ever.

Later addendum: In this article my characterization of nicotine use as a distraction is a simplification and generalization and does not mean to suggest that it does not form a more substantial (or additional) benefit for many.

I thought this would be the last in the series but it looks as though there is more to say; there may be intervening posts from others but almost certainly there is a Part 4 just around the corner.

-Paul L. Bergen

FCTC: Constructing a new assault on smokeless tobacco and electronic cigarettes: Part 2: more misinformation

This the second of a series on this latest development at the FCTC. See Part1: Background.

In a thoughtful overview of smokeless tobacco and its application to harm reduction, Snus Use in the U.S.: Reducing Harm or Creating It? (from the most recent edition of the Journal of the National Cancer Institute) Renee Twombly writes:

“But a 2008 literature review commissioned by the European Union study found that use of smokeless tobacco almost eliminated respiratory disease and substantially cuts the hazard of other health effects, such as cardiovascular disease and oral and gastrointestinal cancers. The exception, they and other experts say, is highly carcinogenic smokeless tobacco produced and consumed in India, Southeast Asia, and northern Africa, which increases oral cancer risk.”

This passage from this relatively modest though learned journal manages to convey that smokeless tobacco is a category shared by products that have very different health risks. However, for some reason, the Convention Secretariat report, supposedly representing an analysis of the most current and in depth information on the subject, (as we would hope since it is intended to influence global policy and millions of lives) is a grade school level essay in comparison in which all manifestations of smokeless tobacco around the world are characterized as one basic undifferentiated product. The different ones are listed off but there is no attempt to distinguish among the wildly varying risk levels of these very different substances. Its as if, and I suppose we may one day have that unhappy day as well, alcohol was the target and all beer (including light beer), wine, spirits, moonshine and every exotic unusual liquor, were treated as one substance.

Another inappropriate generalization is made in the following on page 1:

“Until recently it was erroneously believed that smokeless tobacco was a less harmful alternative to smoking tobacco as it did not contain PAH. This assumption was proved to be wrong by recent research that has established that moist snuff becomes contaminated with PAH during the curing of tobacco leaves required for its preparation.”

Though PAH levels are worth studying, they are not the reason smokeless tobacco is a less harmful alternative; it is less harmful because, when compared with smokers, people who use it live longer and have lower levels of disease. (And while there are many stated disease associations and other health statements in this report that are quibble-worthy, this ground has been covered enough times already that these insufficiencies will be ignored in the interests of a not too long post).

But now that it has been established that all smokeless tobacco is pernicious, it needs to be emphasized that there is no possibility of a rational increase in demand for smokeless tobacco (whether motivated by health concerns or simply by preferring it to smoking) but only an increase in response to untoward machinations on the part of Big Tobacco. On page 3:

“The tobacco industry, however, is expanding its operations in developing countries and increasingly places an emphasis on smokeless tobacco products. The tobacco industry regards smokeless tobacco as a low-cost and highly profitable vehicle for creating dual users (those who use smokeless products along with cigarettes), whose addiction to more than one product makes cessation very difficult. The tobacco industry is also promoting the use of smokeless tobacco as an alternative in countries that have made good progress in ensuring smokefree environments.”

It turns out that smokeless tobacco and its marketing is actually evil in intent. Persistently nudged by tobacco companies, users will add this to their current smoking, and thus make cessation even less likely (see this previous post for a discussion of this nonsense or Brad Rodu’s take on it) . Not only that, and that last sentence has a wondrous lack of any logic, this will also happen in countries with good smoke-free environments. If one were to attempt any logical construction with the elements of that sentence it would be something along the lines of smokeless tobacco helping to maintain smoke-free environments.

And because electronic cigarettes are the great new epidemic (how they love that word) they have to act before even more people use them to quit smoking (at least stop them before too many people use them to quit smoking before they are proven in randomized controlled trials that they can help people quit smoking). On page 5:

“[Electronic cigarettes] should be regulated as nicotine delivery devices, and where this regulation is not possible under tobacco control laws, should be subject to regulation of contents and labelling, prohibitions against use in public places, and restrictions on advertising, promotion, and sponsorship.”

If I read this correctly, they are suggesting that if local tobacco laws do not cover these new devices, go ahead and prohibit them anyway like any tobacco product. Oddly enough, and though there are reasonable arguments to treat them as tobacco products, they do not produce tobacco smoke which is the basis for many of those existing regulations. But of course, as they love to repeat, and I will repeat it here as well: “Nicotine is a highly toxic and addictive substance that poses a serious risk to health. Nicotine and nicotine products for human use should be regulated.” (Page 6). This leads off the arguments against electronic cigarettes and given the prominence you wonder how they could ever use this demon substance in Nicorette or other pharmaceutical cessation aids.

In regards to smokeless tobacco, the Secretariat writes of control and prevention but there is no hesitation in considering banning when discussing e-cigarettes –banning and the protection of public health (on page 5). And this relates to what we’ve written about before here and there about anti-tobacco activism in general in that one of the key problems is that this product is not being placed in the context of a population that for better or worse likes to and continues to smoke but rather in some fantasy of a nicotine free world. Protecting public health is as much about providing safer alternatives for desired yet risky practices as it is about making sure products are safe. It is all about that balance, and the FCTC is sitting firmly and heavily on one end of the nicotine teeter totter watching as users are flying into the air and risking possible injury.

The next and perhaps last post in this series will discuss the confusing arguments around the pricing of smokeless tobacco products (for instance why they should never be cheap but why it is criminal that they strain subsistence household budgets, and more).

-Paul L. Bergen

FCTC: Constructing a new assault on smokeless tobacco and electronic cigarettes: Background

This a first of a series on this latest development at the FCTC.

Though I am not that conversant with the World Health Organization, they seem to do some good in the world, not unlike the FDA. And just like the FDA when they turn their gaze (via the Framework Convention on Tobacco Control) onto tobacco and nicotine, it all goes to hell.

Meeting this November in Uruguay, the FCTC will have on the agenda the new report Control and prevention of smokeless tobacco products and electronic cigarettes. As indicated in the title, the path is already determined, -control and prevention. (The authors are listed as the Convention Secretariat so it is unknown as to whether these are the usual folks repeating themselves or new ones joining in on the scorched earth tobacco policy that maintains the disease levels that they themselves love to invoke as motivating their actions).

This is not unexpected.

If you examine the guiding document of the FCTC, you will already see in place injunctions against any sort of harm reduction.

For instance on page 7:

Towards this end, each Party shall, in accordance with its capabilities:
(b) adopt and implement effective legislative, executive, administrative and/or other measures and cooperate, as appropriate, with other Parties in developing appropriate policies for preventing and reducing tobacco consumption, nicotine addiction and exposure to tobacco smoke.

If you have as your stated purpose the prevention and reduction of nicotine addiction which is characterized in the new paper as “a highly toxic and addictive substance that poses a serious risk to health” you effectively remove the possibility of reducing the health risks to continuing users. The goal of “reducing tobacco consumption” also dismisses the idea of there being safer alternatives.

This becomes even clearer on page 9 where signatories are commanded:

“do not promote a tobacco product by any means that are false, misleading, deceptive or likely to create an erroneous impression about its characteristics, health effects, hazards or emissions, including any term, descriptor, trademark, figurative or any other sign that directly or indirectly creates the false impression that a particular tobacco product is less harmful than other tobacco products.”

How can you create a false impression of something being true when in fact it is true? There is no doubt that some tobacco products are safer than others. Once again, if there is no allowance for safer products there can be no legitimate alternatives for smokers (other than quitting, and as we know, for some that just does not work).

But as much as they do not wish to aid smokers looking for safer alternatives, they do embrace harm reduction when it comes to displaced employment which might result as a result of their actions. From page 20:

“(ii) assisting, as appropriate, tobacco workers in the development of appropriate economically and legally viable alternative livelihoods in an economically viable manner; and (iii) assisting, as appropriate, tobacco growers in shifting agricultural production to alternative crops in an economically viable manner”

The FCTC thus is insensitive to the health concerns of recreational nicotine users but quite concerned about any effects on income. (Not that they are actually following through on this promise … see this news item).

Overall, this document is all top-down, orders from the gods above to the users who are discounted as having no contribution to make to the debate. The paternalistic tone is most obvious in this gem from page 2.

“[we are] Deeply concerned about the high levels of smoking and other forms of tobacco consumption by indigenous peoples,”

It is both criminal and sad that millions of dollars and institutional support go to this powerful institution who clearly are moving toward prohibition at all costs, who sacrifice public health in their quest for a tobacco free world, and do not understand that the use of nicotine is more than just mindless addiction.

-Paul L. Bergen

The usual clueless complaints about spending on anti-smoking

Does anyone recall any articles about proposed or actual government anti-smoking spending that did not follow the same script as the recent ones (NYT, PressConnects) that complained about U.S. state government spending?

Reported spending on anti-smoking programs was $X (it does not matter what X is) and the anti-smoking activists complain that this is far less than the governments collect in sales taxes and MSA money, implying that somehow they are entitled to the full take. Sometime they even claim, contrary to all evidence, that if they were “fully funded” then they could work miracles.

(Part of the propaganda is that the Master Settlement Agreement payments come from the manufacturers, but it is effectively an additional national sales tax, arguably created in violation of constitutional rules about who can impose taxes, but that is a different story.)

Do the anti-tobacco extremists really think that nothing else government spends money on has any benefit, and thus there is no reason to spend money on anything other than their projects?

I recognize that they seldom seem to have sensible policy analysis in their repertoire — witness how often one of them writes, in effect, “this small study looked at one chemicals analysis (or maybe health endpoint) in isolation, without any consideration of the big picture or any mention of economics, benefits, policy, etc., and based on these results we conclude that the entire world should change public policy regarding nicotine products as follows….”

(For readers interested in an illustration of this phenomenon, the best recent example is the study of PAHs in smokeless tobacco by the anti-THR group at the University of Minnesota. This was a single non-replicated study of limited scope that did not even address human health outcomes, let alone offer any cost-benefit analysis of manufacturing changes. Yet the authors breathlessly concluded that, “Urgent measures are required from the U.S. tobacco industry to modify manufacturing processes”. This policy declaration would still be absurd – completely unsupported by the study results and delving into realms beyond the authors’ apparent expertise — even absent the fact, as Brad Rodu reported in detail,, that the study found levels of chemicals that were so low that any potential health risks lie between trivial and none.)

But even given the behavior of the extremists, you would think that a news reporter would occasionally stumble upon someone to interview about this whose education included one course on law and economics or applied micro, and thus could explain that there is absolutely no reason to expect that the optimal amount to spend on smoking cessation bears any relation to what is collected in cigarette taxes. The most obvious reason for this conclusion is that U.S. states and other governments are taxing the heck out of smokers for the purpose of making ends meet because it is the one tax increase that they can usually get away with without complaint. So of course not all of the revenue is going to anti-smoking – that was never what the taxes were designed for.

But even if the taxes were entirely based on the goal of discouraging smoking, rather than just seeing smokers as a convenient ATM, there would still be no reason to expect that spending it all on anti-smoking would be useful. A simple analogy is that some governments put deposits on soda bottles, batteries, and other objects to increase the chance that they are recycled rather than littered. But whatever the government might net from this (because not all the bottles are returned and the government can choose to claim the balance for itself rather than letting merchants keep it) is not necessarily the right amount to spend on anti-littering campaigns. This is obviously the case since some jurisdictions collect a lot of money this way while some collect none at all — which is, of course, similar for cigarette taxes. An even simpler illustration: If a government collected no money because it did not impose bottle fees or cigarette taxes, would that mean that the optimal level of spending on anti-littering or anti-smoking would be zero? Obviously not.

So what determines the right amount to spend?

Anti-smoking efforts, like all government projects, should be funded until the value the next dollar produces is as high as the value that would come from the next dollar of spending on education, roads, police, social services, and whatever else competes for scarce resources. Spending more than that lowers overall social welfare by taking away from a better use of the money.

So what about the marginal product of a dollar spent on anti-smoking?

It is quite difficult to assess, which is probably why those who want that money can get away with saying “gimme more, more, more!”, but my guess is that a careful analysis would reveal is that an extra dollar on top of the billions already spent produces approximately nothing. It might be that the first few hundred million spent on the most useful targets is helping hundreds of thousands of people a year become nonsmokers. (It might also be that even this slice of the budget accomplishes almost nothing because social forces and common knowledge so dominate smoking behavior – we cannot really know because the assessments of the effectiveness of interventions are generally pretty useless.) But beyond some expenditure, there are clearly severely diminishing returns.

Evidence for this is patent: There is so much spent on silly advertising, pointless research, and barely-useful cessation aids that we clearly have run out of ways to spend the money on high-payoff anti-smoking efforts. If activists who call for bigger budgets have such good ideas about how to spend more money on new projects, why are they not redirecting the portion of the first couple of billion per year that is clearly wasted?

Meanwhile, the U.S. states are in a nasty financial situation, with difficulty paying for schools and other basic services. It is a reminder of the egocentrism (i.e., inability to recognize that other people have different viewpoints or preferences) of the anti-tobacco extremists that they do not seem to care that meeting their demands might well mean that someone goes hungry. Just to keep things in perspective, I should note that the net social damage done by overspending on smoking cessation in the U.S. is trivial compared to the Framework Convention on Tobacco Control demanding that countries with health budgets of a few dollars per person-year devote substantial resources to anti-smoking efforts. If poor countries keep the promises they were arm-twisted into making, the social costs will be enormous. This should clearly illustrate that calling for more spending on anti-smoking eventually becomes grossly unethical. The Framework Convention demands are so extreme in trying to direct public money away from where it is desperately needed and giving it to one special interest group as to nearly fit the definition of embezzling or at least major corruption.

The issue of diminishing marginal benefit reminds me of the same principle manifesting in a different way: When I first started doing research in public health, in the mid-1990s, I was quite interested in trying to help reduce the health burden from smoking. But after observing how many people were working in that area and what they were doing, it became apparent to me that the marginal contribution was basically useless, and that the area was (already back then!) grossly overpopulated. Thus, though the issue was the biggest public health issue in rich nations all totaled, the marginal contribution another researcher (like another million dollars) could make was quite small. So I decided to focus my attention elsewhere.

Of course, if I had been more open minded at the time and looked past the orthodox discourse, I might have found the THR work of Rodu and a few others and realized there was an under-populated and potentially valuable area to work on. I only discovered that half a decade later and by accident. (I try to remind myself of that now and again when I get frustrated with people who are genuinely interested in promoting public health but are tricked by the anti-tobacco extremists’ rhetoric into believing that harm reduction is not a good option.) This story does suggest that there may be a few approaches to reducing the health risks from smoking that are indeed underfunded — like, say, harm reduction. Total government and NGO spending on researching and promoting THR is a small fraction of 1% of the total anti-smoking budget (and most of that depends on industry grants). Of course it does not seem terribly likely that the activists clamoring for more state spending want any of it directed to THR since both they and the states have a history of wanting to just do more of what they have been doing even though the marginal value has diminished to zero.

-Carl V. Phillips