The Tragedy of Tobacco and the State: Part 6 – What Then Must Be Done

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Erik Devereux
September 27, 2024

This is the final column in a series on the responses of democratic governments to the public health disaster caused by nicotine addiction (first column, second column, third column, fourth column, fifth column). These columns discuss an intertwined nexus of interests, including governments relying on tobacco tax revenue, that enabled the nicotine industry to continue operating in the United States. This column addresses specifically what should be done by governments to pursue the public interest regarding nicotine.

By 1964 science demonstrated that consumption of nicotine was causing serious diseases and premature mortality. Two broad problem streams became evident:

• Tobacco smoke contains chemicals that cause many cancers and pulmonary diseases (COPD, emphasyma).
• Nicotine contributes to cardiovascular disease, chronic high blood pressure, kidney disease and stroke.

We are too early into the experiment with vaping to have comprehensive data on the health consequences of inhaling the liquids used. There already are public health campaigns alerting the populace that vaping involves exposure to heavy metals, ammonia and other substances known to reduce life expectancy.

Nicotine consumption is never safe. Except for persons experiencing ulcerative colitis, a condition often treated with nicotine, no one else in the population should purchase nicotine products. The public interest requires a complete ban on the manufacture, export, import and sales of such products in the United States.

Each of the components of the proposed ban are important.

Manufacturing. Growing, harvesting and manufacturing tobacco products poses many hazards to the workers from exposure to nicotine in the tobacco leaves. Furthermore, the federal government and states must stop sanctioning the manufacture of these inherently lethal products that are not subject to any constitutional protections. The ban on manufacturing also is important in the consequences of the rules governing international trade.

Import and export of nicotine products. Under the rules of international trade, the United States is within its rights to ban the import if it also bans the export of domestically manufactured products. By ending domestic manufacture of all nicotine products, the United States could impose an import ban without violating norms that prevent nations from imposing restrictions to protect domestic industries from competition.

Sales. No government in the United States should sanction the sale of a highly addictive product for which there is no vaguely safe use. To repeat a common refrain, nicotine products are the only widely available products in the United States for which premature mortality is a known consequence of intended use. We cannot justify the employment and profits associated with nicotine products in the context of their lethality.

For those who raise issues such as “unlawful searches and seizures” or “lack of due process” with the policy measures just discussed, I lift up the example of Coca-Cola. The name Coca-Cola is a reference to cocaine, an original ingredient in American’s iconic “pick-me-up” beverage at the local diner. The ban on cocaine in Coca-Cola seems obvious. Also obvious is the ban on nicotine products.

What about the millions of people in the United States currently experiencing nicotine addiction? They will need a medical process to wean off nicotine under the supervision of a clinician. That would occur in the context of not having nicotine sold over the counter to avoid long-term dependency on replacements such as the patch or gum.

What about the workers who will be displaced? They will require short-term supports as they transition to other employment. The United States has done the same with other industries that went into the dust bin of history.

As for those people who require nicotine to treat an illness such as ulcerative colitis, the federal government already has well-established procedures in place to supply prescription access to nicotine under strict medical supervision. Will that system get abused occasionally? Of course it will. However, the transaction costs involved will be large and the ultimate consequences of accessing nicotine fall short of why the medical cannabis industry became a big joke.

Will a complete ban on nicotine products generate a black market? Of course, but without domestic production the price of illegally imported nicotine products will be well beyond the reach of most Americans. If the wealthy want to damage their health this way, at least they have the money to pay for future medical care.

Finally, there will be considerable benefits for governments by abandoning nicotine tax revenues. Taxation related to governments being invested in harming public health is not a path to legitimacy. When governments are invested in this way, they amplify cynicism about the public sector and our system of governance. The only reason the nicotine industry in the United States survived the 1964 Surgeon General’s report linking cigarettes with lung cancer was brute force industrial power expressed through an overly receptive federal government to campaign contributions and lobbying. The lesson here is not just that greed ultimately kills millions of people who became addicted as children, but that it also can undermine the legitimacy of our government. This is a bright line in the sand that needs to be respected and not crossed again.

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Author: Erik Devereux is Teaching Associate Professor in the Department of Public Policy, Management, and Analytics at the University of Illinois-Chicago. He has a B.S. from the Massachusetts Institute of Technology (Political Science, 1985) and a Ph.D. from the University of Texas at Austin (Government, 1993). He is the author of Methods of Policy Analysis: Creating, Deploying, and Assessing Theories of Change (available for free here). Email: [email protected]

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