It is not a secret that I dislike tobacco companies. Intensely. I do not see the point of allowing them to sell a product whose value is all in the negative. I am appalled that we are looking for expensive ways to diminish lung cancer mortality before considering a complete ban on this disease promotion apparatus. Yet this story in the LA Times got my goat. Briefly, a woman who has smoked for years and has had smoking-related obstructive lung disease since 1989 decided to sue tobacco companies after developing lung cancer in 2003. The suit has been making the rounds in various levels of courts, since the defendants asserted that she had exceeded the 2-year statute of limitations following the onset of her smoking-caused disease, referring to the 1989 COPD diagnosis. However, the California State Supreme Court has ruled that she can still sue the manufacturers, since she filed her suit within two years of the lung cancer diagnosis. So, why am I bothered?
Well, here is the thing: once you develop lung disease, followed by periodontal disease, as this woman did, had she really remained unaware that cigarettes are bad? That they cause problems? Is it really possible to live in our world and NOT be aware that tobacco kills? And if she was aware and continued to smoke, whose responsibility is it that she developed lung cancer, hers or the manufacturer’s? Well, you say, but the tobacco companies are unethical and lied about making cigarettes more addictive by adding undisclosed ingredients. So, how are we, the consumers, to know? Well, this is pretty simple: We have free will, don’t we? And if you have the free will, you have to exercise some will power, no? Is this not what the human condition is all about?
Consider what would happen if we just let all of our desires run rampant. At the simplest level, who would want to get up early and do back-breaking work to produce food for our communities? And why contain anger at town hall meetings, when my humanity tells me to get into a brawl? These are basic ways in which we conquer our instincts and do what we need to do to live in a society with human beings and other organisms. But what is peculiar is that we have not extended these exercises of will to the area of consumerism. In other words, it seems to me that whichever way the market, and more importantly marketing, goes, so goes the perceived need for personal will and responsibility. Ergo, smoking despite warnings of its dire effects is OK, since the poor soul is addicted, and she can always sue on the back end, while the murderous tobacco CEOs and investors walk away with the profits. I don’t know, I think it is embarrassing to give up your will that way personally.
There are two nuances to this view that I want to express. First, I do believe that cigarette companies are unethical, cruel and in debt to us, but the debt that needs to be paid is to the society, not to individuals. It is a debt to our public health that requires complete withdrawal of their product from the market and a large monetary compensation to promote healthy habits among human beings. Second, I believe that there are shades of this personal vs. societal responsibility balance that are important. Take, for example, food options for an inner city youth who lives in poverty. He may want to exercise his free will to get better nutrition than a $1.25 meal at McDonald’s offers, or spend his $1.25 on an apple instead of a bag of potato chips, but for this he has to go across town, a trip that he does not have the means to undertake. This, folks, is where this young man’s personal responsibility needs to be supplemented with societal commitment to equity.
So, should this unfortunate smoker with severe and life-threatening sequelae of tobacco abuse be able to sue the producer of the poison, even if she knowingly took the poison? I guess as a society we have decided that this is OK, but as an individual I am dubious. Yet it really is in the interest of our common health and wealth to punish and eliminate producers of such poisons as a society. Relying on individuals to do this job is just a perpetuation of the idea that we are not responsible for our actions. And furthermore, this becomes but a small pimple on this giant’s ass, a nuisance, and not a necrotizing fasciitis that is required to kill it once and for all.
Marya Zilberberg, MD, MPH, is a physician health services researcher with a specific interest in healthcare-associated complications and a broad interest in the state of our healthcare system. She is the Founder and President of EviMed Research Group, LLC, a consultancy specializing in epidemiology, health services and outcomes research. She is also a professor of Epidemiology at the University of Massachusetts, Amherst. She blogs at Healthcare, etc.