Images on Cigarette Packs

[roubs]

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http://www.nytimes.com/2011/06/22/health/policy/22smoke.html?hp

What do you all think of this? Effective/not?

I was actually a bit struck that the first comment on this article was:

Nanny state stupidity at its worst.

Yet as we have something called medicare the nanny state will be picking up the tab for a lot of smokers once they turn 65 and get sick. Is it really a leap to get that?

 

[DynamicDidactic]

Anyone know the empirical evidence for this?

These labels are similar to what is done in certain European countries and I doubt it has significantly swayed anyone from quitting smoking. Whether it prevents kids from starting is another question.

 

[cara susanna]

What's next, are they going to start showing pictures of obese people on cupcake packages? Why not show cirrhosis pictures on bottles of alcohol?

I agree with the "nanny state" comment.

 

[Ollie123]

Science on these is comparatively solid relative to many other public health movements, though its important to note that very, very little of it is experimental and there is still a lot we don't know. Regardless, we pretty much know that our current warnings are completely ineffective. We do have a lot of large-scale, correlation studies showing that these may be more effective. RE: cupcakes and alcohol, it may seem a relatively trivial distinction to many, but I do firmly believe the critical distinction is that there is no "safe" or "responsible" cigarette use...even one is bad.

We're trying to figure out what this means for ongoing studies, because we expose smokers to their cigarette packs in a few ongoing studies explicitly to evoke cravings and we aren't sure what (if any) effect these changes will have on acute effects. I've only seen one study on that to date, and it had weird/mixed findings that may or may not replicate.

The fact that they got the quitline number on there was big and critical - it implies this is productive.

I'm certainly biased since this is my area, but I have to disagree with the nanny state argument. Of course, I'm also not exactly against nanny states on issues like this for largely economic reasons. That said, they are not telling people they can or cannot smoke, nor does it affect contents of the actual product (though that is obviously being discussed as well). Those are all options being discussed, so this 1) seems relatively tame by comparison, 2) Helps us catch up with what countries with better healthcare are doing and 3) Seems a fair counterpoint to corporate dishonesty. This is getting a bit political but while "true" freedom may carry some long-term advantages, there is likely a whole lot of short-term suffering needed to get there. I think the government has a definite role in keeping corporate greed in check, and that a society that refuses to do so in the interest of being "Free" from the government (and enslaved to the dollar) is not a society I want any part in.

 

[cara susanna]

The thing is that most smokers know it's bad for them, they just don't care. I think it's condescending to put those images on boxes like people will just have this realization of "Oh, you mean this can KILL me? I'll stop straightaway!"

And if the research shows this isn't effective, then why do it?

 

[loveoforganic]

Science on these is comparatively solid relative to many other public health movements, though its important to note that very, very little of it is experimental and there is still a lot we don't know. Regardless, we pretty much know that our current warnings are completely ineffective. We do have a lot of large-scale, correlation studies showing that these may be more effective. RE: cupcakes and alcohol, it may seem a relatively trivial distinction to many, but I do firmly believe the critical distinction is that there is no "safe" or "responsible" cigarette use...even one is bad.

We're trying to figure out what this means for ongoing studies, because we expose smokers to their cigarette packs in a few ongoing studies explicitly to evoke cravings and we aren't sure what (if any) effect these changes will have on acute effects. I've only seen one study on that to date, and it had weird/mixed findings that may or may not replicate.

The fact that they got the quitline number on there was big and critical - it implies this is productive.

I'm certainly biased since this is my area, but I have to disagree with the nanny state argument. Of course, I'm also not exactly against nanny states on issues like this for largely economic reasons. That said, they are not telling people they can or cannot smoke, nor does it affect contents of the actual product (though that is obviously being discussed as well). Those are all options being discussed, so this 1) seems relatively tame by comparison, 2) Helps us catch up with what countries with better healthcare are doing and 3) Seems a fair counterpoint to corporate dishonesty. This is getting a bit political but while "true" freedom may carry some long-term advantages, there is likely a whole lot of short-term suffering needed to get there. I think the government has a definite role in keeping corporate greed in check, and that a society that refuses to do so in the interest of being "Free" from the government (and enslaved to the dollar) is not a society I want any part in.

Glad this is your area 😀

Why have there been no attempts (at least none that I've noticed) to diversify away from the information-giving? I guess some sort of warning is necessary for litigation reasons. However, there could be "The drug ..... has been shown effective in helping ease the pain of quitting smoking," "I quit smoking, and with the money I've saved I've been able to ....."

Just different approaches from the same old same old.

 

[Ollie123]

The thing is that most smokers know it's bad for them, they just don't care. I think it's condescending to put those images on boxes like people will just have this realization of "Oh, you mean this can KILL me? I'll stop straightaway!"

And if the research shows this isn't effective, then why do it?

Sorry, realize that wasn't clear. Research shows that current warning labels are ineffective. Current evidence points towards the "upgraded" labels being more effective, though the state of the literature isn't exactly outstanding and is currently nowhere near my relatively arbitrary methodological bar of "well-established". Regardless, right now the existing evidence does show that in fact, what you said sarcastically is exactly what is going on. Keep in mind this is a population-based intervention so that does not necessarily mean that everyone reacts that way (this is a classic public health vs. psychology distinction), or for that matter even a small portion, but if it influences behavior of even 1% of US smokers, it already had a far more profound effect on health than 100 psychologists doing 60 hours a week of smoking cessation therapy for their entire careers would ever have.

I don't necessarily disagree that its condescending, but I also think its short-sighted to say they don't care. That seems akin to the moralistic view of drug abuse (e.g. "They're just weak-willed"). I don't deny willpower plays some role too, but it misses the complexity of the issue. We tend to think about things moving in one direction, but couldn't we just as easily use this same argument against advertising? If I want to buy pepsi I will, why do corporations have to get all up in my business about it? I don't need to see product placement in shows, commercials every 5 minutes, and logos everywhere I look. Obviously I'm not suggesting we ban advertising, just illustrating a point.

RE: information-giving, that is actually a very good point and I largely agree. As I previously mentioned, getting the quitline number on there was a step in the right direction. Think action implementation - having a plan is critical, and information on HOW to quit has been sorely lacking relative to the message that one SHOULD quit (though this is starting to change). If you are interested, you may want to look into the message-framing literature - there is actually a lot of work on it though as usual the implementation is a good 10 years behind the times. We're actually in the process of writing up a grant looking at that very issue (gain vs. loss-framing, and identifying which smokers might be more susceptible to which type of message).

 

[cara susanna]

I phrased that badly, sorry. "Don't care" sounds judgmental and I'm not trying to judge anyone. I mean they're able to justify it or say that it won't happen to them.

Maybe it'd be better if the government put more money towards mental health treatment so people could get help with quitting or address the issues that made them start and make them unable to stop.

 

[futureapppsy2]

IIRC, isn't there fairly strong empirical evidence that "scared straight" tactics in general don't work (e.g., DARE, some of MADD's stuff)? This isn't my area, so someone with more expertise can feel free to correct me....

Maybe it'd be better if the government put more money towards mental health treatment so people could get help with quitting or address the issues that made them start and make them unable to stop.

I'm fairly indifferent to these new labels in general, but I do think this is an important issue to address, particularly as nicotine can be used as form of self-medication for some disorders.

Has research actually found any strategies for quitting smoking with a high rate of long-term success, though? IIRC, the literature was pretty bleak, which makes me think better treatment of co-morbidities that could lead to or maintain smoking might be better than targeting smoking directly. But again, not my area, so I'm more than open to correction...

 

[roubs]

What's next, are they going to start showing pictures of obese people on cupcake packages? Why not show cirrhosis pictures on bottles of alcohol?

I agree with the "nanny state" comment.

What do you think of the point that the state ends up paying medical costs for smokers' illnesses? Isn't it a legitimate interest to keep these costs down through public health initiatives, not to mention the personal benefits to the individuals/lives saved?

Also Ollie is 100% correct though I'm not as steeped in this area, the point is: We may say a doctor asking a patient to quit smoking is silly and ineffective, but every doctor asks every patient to do this at a GP visit, and 1/100 pts listen to them and successfully quit, the intervention is effective on a population wide scale and is insanely cost effective considering they spent the $ on a doctor's visit anyway. This is similar.

they just don't care

Really? No addictive process going on here? Move along? 😛

 

[Ollie123]

DARE actually ranges from ineffective to counter-productive (I believe at least a few studies have found it increased drug use). Can't speak for MADD, but I view them as a bunch of relatively useless political activists who think anger is an appropriate substitute for knowledge.

I'm not sure you can generalize from a program like DARE to cigarette warning labels or "Scared straight" tactics as a whole though. There are a lot of potential mechanisms at work. I'm also not saying scared straight is the way to go (by any means), I just think the answer is going to be far more complex (i.e. "Scared straight works for some people, when delivered at the appropriate time, when they are in a particular mood and in an appropriate context, whereas gain-framed messages will work for another subset of people in the opposite mood...etc.).

 

[cara susanna]

Well, in an ideal world we wouldn't be paying for smokers' healthcare, either. Plus I still think we hold a double standard with alcohol.

roubs: I already apologized for my earlier wording. Though I meant that more about starting than quitting. Yes, there are people who started smoking before the research was out and I feel for them, but there are also plenty who started after the Surgeon General's warning.

Not to mention that people eventually become desensitized to graphic images.

 

[Therapist4Chnge]

Helpful: Quit line, online support (limited), motivational interviewing, use of multiple methods (med + nic replacement), etc.

Not Helpful: Scare tactics. DARE is a great example, so are some of the abstinence programs that attempted to utilize scare tactics. Horrid failures.

 

[Ollie123]

Can't keep up with the posts!

futureapp: The efficacy of current treatments can also be framed both ways🙂 When we throw everything we've got at smokers, we can double to triple the rate of successfully quitting. However, that number is so low to begin with, we are still talking about ~75-80% relapse rate within about a year.

I agree with the need for developing better treatments (obviously). I think that will likely be more fruitful than trying to find out the reasons people start (though progression to regular use might be a happy middle-ground to target). I have no real basis for that, other than that prevention work is notoriously far more difficult to achieve.

RE: Co-morbidities, definitely an important issue. Still a bit of "chicken or the egg" for some cases in terms of which comes on board first, and in some situations (e.g. depression) they may have a reciprocal relationship. Definitely an area that needs more explanation, but there are still plenty of otherwise mentally "healthy" people smoking, and I'd find it hard to justify dooming millions to die while we spend the next 100 years trying to find a cure for schizophrenia😉 No reason we can't work towards both, and again, as interventions go if these warning labels are even slightly effective they will be HUGELY cost-effective relative to just about anything else we could do.

 

[FadedC]

This seems a bit different then what has been tried in the past, given that there is what I'd consider to be a fairly aversive image on the packaging itself. This is a lot different then just putting up scary posters in the subway, this is adding an unpleasant experience to the proccess of buying or looking at the actual product. There is certainly reasonable theoretical evidence to suggest that this would have an effect on buying behavior, but of course it's impossible to conduct true experiments around this type of thing.

As for whether it should be done, well in some ways it does seem wierd to allow a product to be legally sold and then to go to so much effort to discourage people from buying it. But if it means less lung disease and less goverment medical expenses then I have no problem with it.

 

[cara susanna]

I think it would make more sense just to put a ridiculous tax on the product.

 

[FadedC]

I think it would make more sense just to put a ridiculous tax on the product.

That was one of my first thoughts, but the tax couldn't be too ridiculous or you'd just drive sales underground.

 

[Ollie123]

I think it would make more sense just to put a ridiculous tax on the product.

Don't necessarily disagree, though that dramatically increases the likelihood of black markets emerging, which the current method does not. Regardless, taxation is by far the most effective intervention to date.

Wouldn't a ridiculous tax-rate be 1000x the nanny-ness though?😉

 

[thewesternsky]

We've had these labels in Canada (with pictures) since 2001, and the research conclusion here is that they at least don't hurt and are likely somewhat effective. There is at least one study showing that when the new labels were introduced (though the number of people smoking did not decrease), the average smoker cut back by about two cigarettes a week.

More consistent evidence comes from large-scale studies that show that people are more likely to think about quitting and more likely to call quit lines after the introduction of graphic labels. Thinking about the labels is associated with subsequent quit attempts. Also, although "everyone knows that smoking is bad for you," the labels also increase people's *specific* knowledge of the dangers of smoking (e.g., increased risk of stroke and of mouth cancer).

I think they're kind of charming. 🙂

 

[roubs]

Well, in an ideal world we wouldn't be paying for smokers' healthcare, either. Plus I still think we hold a double standard with alcohol.

roubs: I already apologized for my earlier wording. Though I meant that more about starting than quitting. Yes, there are people who started smoking before the research was out and I feel for them, but there are also plenty who started after the Surgeon General's warning.

Not to mention that people eventually become desensitized to graphic images.

I don't really disagree with you that it's unfortunate to pay for smoker's healthcare, but do you really think it would be humane to say "if you have X diseases we're throwing you off medicare, so you can just die now." or are you proposing something other than restricting medicare?

As per your second point, are you suggesting that because it's common knowledge that certain substances are addictive, we can then blame people who have substance use disorders for having them? It may seem condescending to some people, but to others who are a bit more ready to quit.. contemplators to use stages of change lingo..it could be a jolt. And as this is a public health scale intervention, do we really care if pre-contemplators feel offended if it gets a certain number of contemplators to call the quit line and get going?

 

[roubs]

We've had these labels in Canada (with pictures) since 2001, and the research conclusion here is that they at least don't hurt and are likely somewhat effective. There is at least one study showing that when the new labels were introduced (though the number of people smoking did not decrease), the average smoker cut back by about two cigarettes a week.

More consistent evidence comes from large-scale studies that show that people are more likely to think about quitting and more likely to call quit lines after the introduction of graphic labels. Thinking about the labels is associated with subsequent quit attempts. Also, although "everyone knows that smoking is bad for you," the labels also increase people's *specific* knowledge of the dangers of smoking (e.g., increased risk of stroke and of mouth cancer).

I think they're kind of charming. 🙂

I think they should have included a picture with wrinkles. When my roommate wanted to quit I showed him a list of 20 known consequences of smoking including 6 types of cancer and then he got to the bottom of the list and was like "Wrinkles??? I'm quitting!" Getting at people's vanity is a whole different approach than getting at health consequences and I'm sure it would work for a certain # of people.

 

[thewesternsky]

I think they should have included a picture with wrinkles. When my roommate wanted to quit I showed him a list of 20 known consequences of smoking including 6 types of cancer and then he got to the bottom of the list and was like "Wrinkles??? I'm quitting!" Getting at people's vanity is a whole different approach than getting at health consequences and I'm sure it would work for a certain # of people.

Nice. One of the more interesting labels we have is about smoking's effect on oral health... The teeth in the picture are not pretty! There was talk of updating the labels late last year, but it seems to have (sadly) been scrapped. Hopefully they'll be updated soon, and with wrinkle-pictures!

 

[Ollie123]

I think they should have included a picture with wrinkles. When my roommate wanted to quit I showed him a list of 20 known consequences of smoking including 6 types of cancer and then he got to the bottom of the list and was like "Wrinkles??? I'm quitting!" Getting at people's vanity is a whole different approach than getting at health consequences and I'm sure it would work for a certain # of people.

That one has actually been around for years and is quite common...lots of the television ads and other anti-smoking messages have used that one. I'm surprised it didn't make it onto the packaging, but I expect we'll see it in the near future.

 

[Therapist4Chnge]

I think it would make more sense just to put a ridiculous tax on the product.

I wish it were that simple. A pack of cigarettes is ~$10 in many NYC boroughs, yet people still smoke. Cost is a consideration, but many people will use other means to continue smoking: rolling their own, going to other states to buy them more cheaply, going to an indian reserve, etc. I primarily use motivational interviewing and a bunch of targeted research findings: greater likelihood of ED (men), wrinkles/aging (women), BP increase, slower to heal post-surgery (I had a ton of cardiac/surg referrals), mouth cancer (with pictures!). For the young guys who dipped I found the pictures to be helpful, particularly when I talked to them about feedback from their gf's/wives about their dipping. Libido can be a powerful thing.

 

[cara susanna]

I don't really disagree with you that it's unfortunate to pay for smoker's healthcare, but do you really think it would be humane to say "if you have X diseases we're throwing you off medicare, so you can just die now." or are you proposing something other than restricting medicare?

I'm proposing something else, that I won't get into because it would throw this thread way off track. 😉

As per your second point, are you suggesting that because it's common knowledge that certain substances are addictive, we can then blame people who have substance use disorders for having them? It may seem condescending to some people, but to others who are a bit more ready to quit.. contemplators to use stages of change lingo..it could be a jolt. And as this is a public health scale intervention, do we really care if pre-contemplators feel offended if it gets a certain number of contemplators to call the quit line and get going?

That's true. I just think it's odd to acknowledge "this product is most likely going to kill you" but still allow its sale. Granted, then you get into the drug war question, which is far more complex. I still don't know how I feel about that issue because it makes me argue endlessly with myself.

 

[roubs]

I don't think it's strange to discourage something yet refrain from outlawing it. As other posters have mentioned, creating a black market for something has other nasty consequences.

 

[futureapppsy2]

Can't keep up with the posts!

Maybe it'd be better if the government put more money towards mental health treatment so people could get help with quitting or address the issues that made them start and make them unable to stop. No reason we can't work towards both, and again, as interventions go if these warning labels are even slightly effective they will be HUGELY cost-effective relative to just about anything else we could do.

I think your last sentence is a really good point and one I didn't think of (because while I do intervention research, it isn't large-scale)... even a 1% or .1% decrease in smoking-related diseases would be great when spread out over 300 million people. Of course, a larger effect would be pretty much always be better, but when you're dealing with a huge population, even a small change would be notable. Still, I do think it's important to conduct rigorous research on the effectiveness of such labels and not just say "well, they probably won't do any harm even if they don't work" (not saying that anyone on this thread is saying that, but I've heard it elsewhere). It's a quandary.


As the healthcare issue, I'll just say (and probably regret doing so 😉 ) that I have serious ethical issues with assuming blanket cause/blame for disease/illness on an individual level. Yes, smokers, statistically, account for the lion's share of lung cancer cases, but non-smokers get lung cancer as well. Yes, poor pre-natal care increases the risk for pre-maturity/birth defects, but an individual mother can follow every pre-natal guideline and still have a baby with severe birth defects. This isn't to say that prevention programs or correlations should be thrown out by any means, but that I get very wary when people try to transfer population-based stats onto every individual case. Of course, I have a rather personal background for this opinion, so I'm admittedly not the most unbiased commentator by any stretch of the imagination....

I don't think anyone here is saying that, but it often creeps into discussions on large-scale prevention efforts--a bit of a just world hypothesis, maybe?

 

[Ollie123]

"well, they probably won't do any harm even if they don't work" (not saying that anyone on this thread is saying that, but I've heard it elsewhere). It's a quandary.

Definitely agree. I actually emailed my adviser about this issue earlier to see if we can look into the acute effects. There is some basis to suggest they could have a paradoxical effect...negative affect definitely increases urge to smoke (we're talking acute now, not just "Depressed people are more likely to smoke"). Would the smoking-related context overwhelm any effects on mood? "Scary" images tend to capture attention. Would people habituate to the effects of the warning labels on motivation to quit, but now have their attention increasingly "drawn" to cigarette cues in their environment?

All unanswered questions. Despite the above, I'm still relatively confident that in the long-run these would come down as having a net positive effect, but they are important factors to consider.

 

[cara susanna]

Please let us know the results if you end up doing such research, Ollie. I'd be very interested to hear them.

Or a citation would be equally appreciated 😀

 

[Ollie123]

Far from the final word (I really dislike the dot-probe though that is a discussion for another day), but here is one of the only studies I've seen looking at acute effects of packaging and the results are funky and do indicate a paradoxical effect that first got me thinking about this. Not a bad study by any means, but attentional bias effects are notoriously flaky and I'm not sure how much "data massaging" went into this.

If we do pursue research on it, the results will likely be years down the road...we are not the sort of lab that does small, concise projects (which is both good and bad).

http://www.sciencedirect.com/science/article/pii/S0091305711000244

A quick google scholar search will pull up a bunch of large n, correlational articles that show the support for this.

 

[loveoforganic]

RE: information-giving, that is actually a very good point and I largely agree. As I previously mentioned, getting the quitline number on there was a step in the right direction. Think action implementation - having a plan is critical, and information on HOW to quit has been sorely lacking relative to the message that one SHOULD quit (though this is starting to change). If you are interested, you may want to look into the message-framing literature - there is actually a lot of work on it though as usual the implementation is a good 10 years behind the times. We're actually in the process of writing up a grant looking at that very issue (gain vs. loss-framing, and identifying which smokers might be more susceptible to which type of message).

Cool stuff! thanks

I think they should have included a picture with wrinkles. When my roommate wanted to quit I showed him a list of 20 known consequences of smoking including 6 types of cancer and then he got to the bottom of the list and was like "Wrinkles??? I'm quitting!" Getting at people's vanity is a whole different approach than getting at health consequences and I'm sure it would work for a certain # of people.

Interesting you mention, intro behavioral today brought up an erectile dysfunction-targeted social marketing campaign for diabetes being the most effective by far

 

[CharmedDiamond]

I wish it were that simple. A pack of cigarettes is ~$10 in many NYC boroughs, yet people still smoke. Cost is a consideration, but many people will use other means to continue smoking: rolling their own, going to other states to buy them more cheaply, going to an indian reserve, etc. I primarily use motivational interviewing and a bunch of targeted research findings: greater likelihood of ED (men), wrinkles/aging (women), BP increase, slower to heal post-surgery (I had a ton of cardiac/surg referrals), mouth cancer (with pictures!). For the young guys who dipped I found the pictures to be helpful, particularly when I talked to them about feedback from their gf's/wives about their dipping. Libido can be a powerful thing.

I live in Chicago, where packs are regularly 9-10$. It really doesn't discourage people! They chose to go without other items to buy their cigarettes, order them online, or drive to the suburbs/other counties, or even other states! I had a friend in college that would order Marlboro from Russia because it was cheaper!

I also read through the story and saw all of the originally proposed pictures. I have to say that I'm surprised with the sets of images they chose! A few of those had much more shock appeal.

As a former smoker, I can say those images would NOT have deterred me. Yes, I knew better, and I knew what could happen, but at the time the short term stress relief and social acceptance given by smoking was worth the long term risks. My friends that I attempted to persuade later into quitting knew better as well, but didn't care, saying that those last few years were "crappy" anyway. Small and biased sample, but straight from the horse's mouth. I DO think however, it might have stopped me from starting. Maybe. Pissed off teenagers aren't well known for their logic!

Maybe we should offer free Welbutrin to smokers that want to quit. Now there's an idea! Maybe not practical, but definitely radical.

 

[Ollie123]

Some additional citations that were circulated on the SRNT listserv copied below.

Charmed - its simply incorrect to say it doesn't discourage people. I see lots of people who still experience depression despite getting therapy, does that mean therapy doesn't work? We are working on averages here, and the results are extremely consistent...as the price goes up, the smoking rate will go down. Each $1 tax has way more influence than 100 psychologists doing it full time ever could. There are other arguments against it, some of which I've already made (we don't know when we'll hit the critical point for a substantive black market to emerge), but it would be pretty tough to argue that it doesn't work.

Biener, L., McCallum-Keeler, G., Nyman, A.L. (2000). Adults’ response to Massachusetts Antitobacco Television Advertisements: Impact of viewer ad characteristics. Tobacco Control. 9,401-407.



Durkin, S.J., Biener, L., Wakefield, M. (2009) Effects of different types of antismoking ads on reducing disparities in smoking cessation among socioeconomic subgroups. American Journal of Public

Health 99(12):2217-2223.



Biener, L; Strecher, V. (2008). Chapter 11. An Overview of Media Interventions in Tobacco Control: Strategies and Themes. In: National Cancer Institute, ed. The role of the media in promoting and reducing tobacco use. Vol 07-6242. Bethesda, MD, U.S: Department of Health and Human Services, National Institute of Health, National Cancer Institute; 2008:431-478.

White V, Webster B, Wakefield M. Do graphic health warning labels have an impact on adolescents' smoking-related beliefs and behaviors? Addiction 2008; 103 (9): 1562-1571.

Hammond D, Fong GT, McNeill A, et al. Effectiveness of cigarette warning

labels in informing smokers about the risks of smoking: findings from the

International Tobacco Control (ITC) Four Country Survey. Tob Control

2006;15(Suppl 3):iii19–25.



Hammond D. FCTC Article 11. Tobacco packaging and labelling: A review of evidence. 2007.



Tandemar Research Inc. Cigarette packaging study: The evaluation of new health warning messages. Toronto (ON)1996.

 

[futureapppsy2]

Please let us know the results if you end up doing such research, Ollie. I'd be very interested to hear them.

Or a citation would be equally appreciated 😀

As would I!

Thanks for the citations, Ollie! 🙂

 

[paramour]

I actually know someone in one of my summer courses who saw these pictures immediately after they were released earlier in the week. We are in a substance abuse counseling course and are required to give up an "addiction" for the semester as part of a project. She decided to quit smoking based upon those images because she "never knew how bad" it was for her (e.g., She doesn't want a hole in her throat. She doesn't want bad teeth and gums. She doesn't want lung cancer. She doesn't want to die.) The rest of us in class had not even heard about the images until she informed us about them. Discussing them, you could tell that these images really impacted her.

I was sort of astounded that someone could not possibly know that these were the potential effects of smoking. I've seen images similar to these previously. I knew these were consequences of smoking. How can someone at this age especially NOT know that there are long term consequences, including death, if you smoke?

Interestingly, no one in this class of thirtyish folks objected to the images. I know of some other long-term, heavy smokers. I will be curious to see if any of them are affected by these images.

 

[deleted176373]

Smoking is addictive, that's true.
People can overcome addictions, that's true.
Nanny state solutions are often ineffective, that's true. (See prohibition, DARE, etc.)

If smoking is so dangerous that medicare has a problem funding treatment for smokers because the cost is too high, then don't cover smokers who have not quit.

Simple.

Yes, there are people who started smoking without realizing how addictive it was or simply disregarded the addictive qualities. Every last one of them is capable of quitting smoking right now.

The fact is that people need to be responsible for their choices, including smoking, and not to expect the public to foot the bill. So is it inhumane to not pay their medicare for smoking related illness, no not at all. Medical treatment is NOT a right, it was never intended to be provided by our government.

If government really believed it could contain the costs of smoking through these campaigns, then government could have banned smoking years ago... period... The FDA has had the power to eliminate legal tobacco consumption for decades. Personally, I am against that because it restricts individual freedom and is diametrically opposed to the principles that this country was founded on.

So really it goes back to the original question of should government be providing medical care to private citizens?

The libertarian answer to that is a resounding: No. Medical care is a private concern, and should be funded privately, to even remotely suggest that the government can provide more cost effective health care is laughable at best.

Certainly, if a reasonable person knew that one would not receive medical care for tobacco related illness they might be less likely to engage in behaviors that would lead one to a premature death through smoking or at least force them to shoulder the cost of this choice by paying a higher premium because of their risky behaviors. Although, they would have the option of still engaging in the behavior and choosing to go it alone, that's their choice.

All the nanny state tactics simply are political theater to give the impression that the government is working diligently to solve the problem, when clearly they are doing nothing constructive and wasting incredible amounts of public resources. These ridiculous pictures will do little to curb smoking as most smokers are well aware that what they are doing to their bodies is not good.

Addiction can only be overcome by individual choice, anything less than that conscious decision not to be a smoker will not result in a cessation of smoking behaviors.

Mark