Breaking: 480,000 Americans still die from cigarettes every year

At the Atlantic Monthly, Kenneth Warner and I have a 7,000 word piece called the Nicotine Fix. Ken is one of the nation’s leading tobacco control experts and a former dean of the University of Michigan School of Public Health. It was great to be his wingman on this. We discuss the remarkable, yet incomplete progress America has made in reducing tobacco-related deaths. In the fifty years since the 1964 Surgeon General’s report, efforts to reduce smoking have prevented an estimated eight million deaths. Each of these eight million people received an additional twenty years of human life.

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As educated and affluent people turn away from smoking, it’s easy to forget some basic realities. 480,000 Americans still die of smoking-related causes every year. That’s an amazing figure. Our piece discusses the disgraceful history but more promising history of tobacco harm reduction efforts. Both of my in-laws died harrowing deaths from lung cancer, way before their time. I wish they had access to e-cigs or other products they might have substituted for combustable tobacco.

Incidentally, Ken and I are very grateful to Jennie Rothenberg Gritz and others at the Atlantic. They produced our piece beautifully. We have old tobacco ads and videos, and graphs like the one above, drawn from Surgeon General reports. We hope you enjoy reading it.

The Rarely Acknowledged Public Health Achievements of Obama’s Drug Policy

Obama’s health oriented drug policy reforms are underappreciated

After initially accusing President Obama’s outgoing drug policy director Gil Kerlikowske of opposing public health measures in drug policy, Eric Sterling had the class to publically acknowledge Kerlikowske’s health-oriented reforms:

[Kerlikowske] recognized the importance of stopping the spread of HIV/AIDS among injecting drug users and recognized their humanity and dignity in the way his predecessors did not. Second, in the same spirit, he recognized that the dissemination of naloxone into the environments of opiate users, many of whom are using drugs illegally, would stop overdoses from becoming fatal.

Sterling also praised Kerlikowske’s support of opiate substitution therapies (e.g., methadone maintenance), which the administration expanded within the Tri-Care insurance program for military personnel and their families and spread internationally through the President’s Emergency Plan For AIDS Relief (PEPFAR).

In addition to the points Sterling raised, one could also note that the Administration’s signature legislation — the Affordable Care Act — mandates full coverage in Medicaid and health insurance exchanges for addiction treatment. That’s the biggest stride the federal government has taken towards health-oriented drug policy in at least 40 years and probably ever.

Sterling’s explanation for why his first article was inaccurate is powerfully honest and important:

I insulted Mr. Kerlikowske and dismissed his record on matters I did not review, relying on prejudices I formed regarding other subjects such as drug “legalization,” whether the Administration’s anti-drug program was “balanced,” as he claimed, and on marijuana policy. I deeply regret that I was unfair to Mr. Kerlikowske and misled the readers of Huffington Post regarding his support and commitment on important public health issues.

Sterling was by no means alone in his assumption that anyone who opposes drug legalization also opposes health oriented drug policy reform. But historically and cross-culturally, opinions on those two matters have not intersected in a consistent way. For example, among the people who identify themselves as “harm reductionists” around the world are many individuals who want all drugs legalized and many individuals who regard that idea with terror and hostility (Mainly because of the experience of legal tobacco). Among people who support legalization are individuals who favor increased availability of addiction treatment and individuals who are quite skeptical of the addiction treatment enterprise. And among people who oppose drug legalization –President Obama being a prominent example — are individuals who want to augment the quantity and quality of health services for drug users. Continue reading “The Rarely Acknowledged Public Health Achievements of Obama’s Drug Policy”