None of these douchebags went to jail

The latest in an ongoing series.

It began in 1994.

Years of outrage over decades of Big Tobacco’s lies finally seemed to be coming to fruition. 1994 was the year it seemed like we finally turned a corner in the fight against Big Tobacco.

The early 90s was pretty much the height of the lung cancer epidemic. Ever since then, lung cancer rates overall have been slowly dropping, especially among men. It was also the height of “Joe Camel,” a wildly successful marketing campaign by RJ Reynolds that appealed to beginning smokers (i.e., teenagers). What was really alarming people at the time was that the teenage smoking rate had been steadily decreasing until the mid- to late-80s. Then, shockingly, the teen smoking rate started going up, and going up markedly. Why? Joe Camel. Tobacco paying millions every year to insert “cool” smoking scenes in PG and PG-13 movies. They were finding a way to market to kids.

Congressman Harry Waxman held a famous series of Congressional hearings in 1994 in which the CEOs of the four major tobacco companies were subpoenaed to testify before Waxman’s committee about the cover-up and lies of Big Tobacco. All four CEOs — from RJ Reynolds, Phillip Morris, Brown & Williamson and Lollilard — steadfastly refused to budge an inch under withering questioning from Waxman and other congressmen that they knew cigarettes were addictive and were killing people.

They all four claimed they did not believe this. The public was outraged. It was a major public relations debacle for Big Tobacco. Within months, a perjury investigation was initiated by the Department of Justice. All four CEOs were eventually fired. Ultimately, the Department of Justice claimed it didn’t have enough evidence to prosecute for perjury because the four CEOs testified under oath they believed tobacco did not addict people nor cause cancer. They had crafted their answers very carefully, obviously with help from attorneys. Because they had used the word believe, they could not be prosecuted for perjury.

Then came the Global Settlement Agreement, which came oh, so close to passing. This was a settlement proposed between several plaintiffs and Big Tobacco to right at least some of the wrongs committed by Big Tobacco over the past century. This included payment of $365 billion to the states for their Medicaid costs caused by smoking. FDA would be given regulation over tobacco products, warning labels would be strengthened and all class-actions suits against Big Tobacco would be nullified. This required an act of Congress (because of the FDA involvement), and Congress failed to pass the bill, which was carried by Sen. John McCain.

Harry Waxman, weird-looking hero

Out of the flames of that failure, came the the Master Settlement Agreement, which was announced in 1998, I cheered. Finally, Big Tobacco was being brought to its knees. It wasn’t as good as the GSA, but it still sounded damn good. Big Tobacco would be crushed by a $280 billion out-of-court settlement with 46 states … (give or take several billion depending on your accounting). I continued to cheer it for at least five years … until I started finding out all that had been lost.

All in all, this agreement was an abject failure on most levels, explained very well in Alan Brandt’s fascinating “The Cigarette Century.” The Master Settlement Agreement is to this day the biggest court settlement ever reached in the history of litigation. Big Tobacco (RJ Reynolds, Phillip Morris, Lollilard and Brown & Williamson), was sued by the state of Mississippi in the early 1990s to reimburse the state for its Medicaid expenses caused by all the health problems caused by smoking. 40 other states joined the suit. Famed Mississippi attorney Dickey Scruggs took over the plaintiffs’ case, leading an army of lawyers against Big Tobacco.

The case had an interesting basis in law. The tobacco industry was adding untold billions to the Medicaid expenses of states dealing with the near-epidemic of health problems caused by cigarettes — lung cancer, heart disease, lung disease, etc. In the 70s and 80s, lung cancer especially hit a crescendo as all those heavy smokers who started smoking in the 1950s and 1960s (when the smoking rate was the highest) started getting lung cancer. The industry knew damn well that its product was making people sick, yet continued to sell it … and this was actually adding to taxpayers’ tax burdens. All this information came out in a series of documents leaked over a period of years from various personal injury lawsuits against the tobacco industry. While few of these lawsuits succeeded (Most jury decisions for the plaintiffs were either overturned by higher courts or the damages greatly reduced), one good thing did come out of all this litigation. Discovery.

Scarlett Johansson, making smoking cool onscreen

Through the discovery process, reams and reams of documents were released to the plaintiffs, who in turn made them available to the public, proving that the tobacco industry had known since the early 1950s that tobacco was giving people heart disease and lung cancer and that nicotine was physically addictive and that “light” cigarettes were not safer than “regular.” Documents were released showing that Big Tobacco executives did their damnedest to keep this information covered up, and to fabricate studies attempting to disprove that cigarettes were killing people. More documents also proved that the industry had been shamelessly marketing to “new smokers,” which is a Big Tobacco euphemism for “teenage smokers.” With these reams upon reams of evidence now out in the public forum, Big Tobacco was forced to settle, or face constant lawsuits and judgments. However, the high-priced Big Tobacco lawyers completely outmaneuvered the state attorneys general in the settlement.

The biggest failure of the agreement? It was suggested in the agreement that a certain amount of the $280 billion go toward tobacco education and cessation programs. Everyone assumed it would. Everyone thought it was a MANDATE. It was never MANDATED, however.

Anti-smoking programs did receive a lot of funding from the settlement for a few years, but it didn’t take states very long to figure out that the word “mandate” wasn’t in the settlement anywhere. Before long, state legislatures started diverted that money to balancing their general funds. Money for tobacco education dried up. Lazy state legislators got an easy source of money to balance their budget without raising property taxes.

It turned into a huge windfall. Not only that, but states started selling bonds with the intention that they would be paid off by future tobacco settlement funds.

And we’re not even getting into cigarette taxes, which pump billions into state and federal coffers. It is simply not in the states’ and federal government’s interests to really dig into the smoking rate.

Instead of stamping out smoking, states had become utterly dependent upon tobacco.

Joe Camel, officially retired in 1998

There was one last chance to really nail the tobacco industry. A RICO racketeering lawsuit filed against Big Tobacco in the federal court by the Justice Department under Bill Clinton. They had a damn good case. Tobacco executives had conspired for years to cover up the addictiveness and deadliness of their product. They had conspired for years to cover up the fact that they were marketing their product to kids. They had lied that “light” cigarettes were safer. These all violated federal racketeering statutes; the same statutes that had sent numerous Mafia gangsters to prison.

The feds won their case in 2006, sort of. A federal judge issued a scathing ruling convicting Big Tobacco of racketeering under the RICO statutes. An appeals court upheld this decison. However, shockingly, the courts did not impose any financial penalties, saying the RICO statute did not allow this option. Some argue that the Justice Department under Bush did not pursue the case as aggressively as it had been pursued under Clinton, and this was part of the reason for the mixed ruling. The case is still being appealed as the government is seeking more of a monetary punishment against Big Tobacco.

So, tobacco executives lost their jobs for lying to Congress, were investigated for perjury, but avoided an indictment. Big Tobacco was convicted by a federal judge of RICO racketeering, and that conviction was upheld by an appeals court, but no executives went to jail, nor was the industry even forced to pay penalties. A huge civil settlement with the states has simply turned into a windfall for state governments.

Big Tobacco killed people for decades. They knew since the early 1950s, maybe even earlier, that they had a product that was addicting people and was killing people.  And they covered up and lied. For decades. It’s amazing to me that not one person has ever spent a day in jail for it. And people are rotting in prison in Texas and Florida for selling pot. They got away with it. The Crime of the Century.

The final chapter of Dr. Allan Brandt’s book, “The Tobacco Century,” is “The Crime of the Century.” They committed murder. Murder is an extremely strong word, but I believe it is fair in this context. By murder, I mean they knew full well they were killing people with their product, a physically addictive product. And knowing this … they kept selling it, and marketing it … and then they fucking marketed it to children with cartoon characters. And they made fucking billions of dollars.

Murderers. They murdered 100 million people between 1950 and 2010. Wrap your head around that number. 100 million. If anything, that is a conservative number. That is the number of people whose lives were cut short, sometimes by years, sometimes by decades, worldwide, between 1950 and 2010, by tobacco products. The industry KNEW by 1950 their product was killing people. They essentially devastated two or three generations. Yeah, I know alcohol kills people, too, and destroys lives. But, 50 percent of  the people who drink alcohol don’t die as a result. 50 percent of the people who smoke will eventually die of a tobacco-related disease.

I look at my family. My dad … dead of lung cancer at 49. My mom, suffering from COPD for 10 years. Their best friend, dead of lung cancer at 66. Another couple they were friends with … lung cancer and heart disease in their 50s. Another friend. Dead of cancer in his 50s. My uncle, dead of throat cancer at 70. Another uncle, dead of heart disease in his late 40s. All heavy smokers. All wiped out, years and decades lost. Quality of life destroyed for the survivors of this … massacre.

They killed. They lied before Congress. They were CONVICTED of violating RICO.  They beat the rap. Their lawyers were better than our lawyers. They bought off their enemies.

If you want to look at the glass half-full, a few good things did come out of the 1998 MSA:

* Joe Camel was retired for good. Big Tobacco is forbidden from marketing to kids again (no ads with cartoon characters). They have attempted to get around this provision several times.

* Payments to movie studios for product placement were forbidden. Weirdly enough, smoking scenes in movies after 1998 actually went up, not down. Big Tobacco insists they have nothing to do with this. It’s probably Hollywood’s continued love affair with the cigarette dating back to Casablanca. However, pressure has been put on Hollywood to cut gratuitous smoking scenes out of PG and G movies. That pressure seems to be working as smoking scenes in PG movies have gone done.

* The cost of cigarettes went up. To pay for the $280 billion settlement, the industry as expected raised their prices. Along with a number of states jacking up their cigarette taxes, in some cases dramatically, the price of cigarettes has skyrocketed in the past 10 years, helping to drive down the smoking rate.

* Spurred party by outrage that sprang from Waxman’s hearings, more and more states and cities have passed smoking bans. Smoking bans are controversial, but they do help drive down the smoking rate (because a lot of casual smokers only smoke in bars, and therefore, it gives them a good excuse to quit), and they also protect nonsmokers from secondhand smoke. Also, very few people now smoke two to three packs a day like 30 years ago, because of workplace smoking bans. The lung cancer rate has dropped, in the case of men dramatically, in the past few years I think because of this.

* The FDA was given regulatory authority over tobacco in 2009. The first thing the agency did was ban candy-flavoured cigarettes, which are popular with kids.

* The smoking rate and teen smoking rate have declined since 1998, but not dramatically. The smoking rate was around 24-25 percent in 1998, and today it’s pretty much stuck at about 20 percent. The smoking rate for teens is a little harder to pin down, because few teens are what you would call “regular smokers,” but the percentage of teens who were smoking dropped from 28 percent in 2000 to 17 percent in 2010. However, that drop has stalled the last few years, probably because of the cut in tobacco education funding.

* Class-action suits against Big Tobacco have been halted, but individual lawsuits are still being allowed. In Florida, a Supreme Court decision there in 2006 allowed thousands of individual lawsuits to go forward against Big Tobacco for lying about the safety of “light cigarattes,” etc. So far, juries have awarded hundreds of millions of dollars for plaintiffs, with hundreds more suits in the works. None of those judgments have been paid out, however, as Big Tobacco is appealing all the verdicts. the industry will be dealing with these lawsuits for at least the next decade, maybe longer.

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KQµårk 死神snoskierescribacatSabreen60For America and Roosevelt Recent comment authors
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KQµårk 死神

Excellent article and topic.

Nicotine is simply one of the most poisonous substances know to man and has more mutagenic properties than Agent Orange (chlorinated dioxins).

The only thing that truly amazes me about nicotine use is that people live so long as they do using it on a constant basis.

Personally I’m a huge advocate for raising all kinds of taxes on vices, even on sucrose and fructose sweetened beverages, because in the long run those medical costs affect us all.


Thanks you Pepe, for this post,this is a very interesting debate, and one that I hope will spread.

First, I never smoked (tobacco), tried it a few times and it wasn’t for me. I have had girl friends, very close friends, acquaintances, that were smokers.

It appears to me that the rights of smokers have been debated below,and it troubles me that their rights are being infringed upon. The problem with that, is that the rest of us pay for the consequences of smoking. Directly through higher health care costs, directly through second hand smoke, and indirectly through the social trauma that results from shortened lives.

I have stories that mirror many of the experiences below, but I so want to add my heavy smoking friend who had a stroke at 54 and is still not the same. It breaks my heart because I know it was from his heavy habit.

I resent the fact that my state used tobacco funds for general funding, rather than working to eradicate smoking. Currently we are down to 18%, but it should be a lot lower.

As has been discussed below, lower income groups smoke at a disproportionally high rate, which is tragic. They are able to go out to the Indian reservations up here, and avoid paying state taxes, which defeats our efforts to price it out of their hands.

I hope more people are able to break the habit, and I am happy I don’t have to endure second hand smoke in restaurants, bars, public areas, planes, etc. anymore.

Haruko Haruhara

There is a LOT more going on than cancer.

tobacco and diabetes

Tobacco and arthritis

Tobacco and Alzheimer’s

I’m not passing judgement. It’s perfectly legal, but this is toxic shite. I honestly believe that other than meth or huffing kerosene it is the most toxic shite on the planet.


I’m way outta my league, but I’ve heard things about nicotine (isolated) that suggest help with Alzheimer’s, but still has carcinogenic side-effects, even on its own (minus smoke byproducts, added ingredients).

And absolutely there’s a huge correlation with self-medicating and some mental illnesses. I think they did right to call it a rogue substance. Some people, myself included, were drawn to it helping with certain things–like when I’m having trouble keeping focus during a long article or dry book.

But of course, the benefits are far outweighed by the negatives. Clearly. No arguing that. Just saying it’s a sneaky bastard on many levels.

Oh, and as an aside to the original article while I’m writing.

I can think of few good reasons for there to be smoking in a G or PG movie. I might get a little self-consciously defensive, but I can’t think of an objection to that. I have 0% problem with that which I can think of.

I would say that I might add bath salts to toxic substances, though.

And what the hell is really in that fake weed?

Haruko Haruhara

I think nicotine by itself is relatively harmless, other than the addiction … and perhaps the elevated blood pressure. By itself, it’s probably not much worse than caffeine.

It’s all the other shite … formaldehyde, arsenic, toluene, benzene, cadmium, acetone, cyanide, polonium-210. That’s the real problem.

They’ve come damn close to proving tobacco is a massive risk factor for Alzheimer’s.


Well, I’m not contesting tobacco, especially as smoked. And I can certainly see what incentive the tobacco companies would have to push Cotinine, too.

I just thought it was one of those intriguing paradoxes regarding strictly nicotine.


You make a convincing case, Pepe. And I know this issue is near and dear to your heart. I didn’t know that was Waxman who went after Big Tobacco. I was somewhat annoyed with him during the HCR debates but my opinion improves knowing this.

This issue is kind of similar to the censorship issue that we’ve been discussing on Whats’ thread the past few days. Should the government endeavor to eliminate from society those things we consider depraved or deadly? A lot of the same arguments apply here. I for one am really grateful that I don’t have to breathe other people’s smoke when I’m in a restaurant — even though others had to breathe mine for years long ago. Luckily, since I quit, I no longer crave it and seriously dislike the smell. I know other ex-smokers who still want it. It’s a powerful addiction — at least it was for me. This has turned out to be one unpleasant aspect of traveling abroad — smokers everywhere! When you’re not used to it, it’s hard to deal with.

When I was growing up, everybody smoked and I started at 13 just to be cool. I quit a long time ago and it was extremely difficult. I remember buying candy cigarettes when I was a kid. We would light them and it smelled like burnt marshmallow. It was just a given that you could smoke when you grew up. Things have changed.

Having said all that, I do understand how smokers today feel like they’ve been demonized. Hell, maybe that’s a good thing, if it becomes a motivation to quit. I sure wish my beloved beautiful nephew would.


Colbert had part of his “Wag of the Tail” segment, New Hampshire decreasing taxes on cigarettes. “Smoke free and die”.

I’m an ex-smoker who loved smoking. I had no outward symptoms – no cough, etc. I even ran on the treadmill at the time I was smoking. I quit twice. I had quit before my son was born, but started back when he was in his 20’s. I quit again – this time I hope for good. It’s a terrible habit. I never deluded myself – I knew smoking was awful for my body. I just enjoyed it. When smokers became “second class citizens” — (been there, done that, sometimes still doing that) — having to go outside in zero degree weather to smoke was a bit too much. Eventually, I said this is just stupid. I was tired of the smell in my clothes and my hair. I was pretty much trying to hide my smoking from my husband, because he had quit. When something takes control over your life you’re in trouble.

Anyway here’s an article on NH.


At first I naively wondered why they would do that, Sabreen, but then saw in the article that the intention is to draw smokers from other states and increase revenue that way.

Nice way to make money, don’t you think? 🙄


I quit smoking for 18 years then after a divorce the first thing I did was light up. I think once you’re addicted the desire is always there. I did quit again about 5 yrs ago after losing a grandchild to a birth defect that was lung related.

It was surprising that so many of the young pulmonary specialists that worked with my grandson smoked. As adults I still believe we should becable to do as we please, and I’m not sure this shunning of smokers is working with young people – they still seem to be lighting up unfortunately.


Artist, I too smoked years ago, and you’re right, that urge never entirely goes away.

And health care professionals who smoke absolutely baffle me. We see some horrendous things!

I think some young women smoke because they feel it will help with weight control. If they could see a 75 pound person at the end stages, they would think twice. It’s sad. Really.


How many doctors and nurses drive donor-cycles?


Well, again, not to make false equivalencies, but with all the things nurses see, it would debilitate me from doing much of anything!

There’s so many things, and activities that can get you sent there.

Again, not a false equivalency, I’m just neurotic like that.

The fact that health care professionals smoking does baffle me too though. It’s obviously the last profession I would expect it in.


You’re right, Khirad. There are many roads to the hospital.

And really, I and the people I work with are not into blaming people when they’re in the hospital. After all there are the smokers, drinkers, fast-food junkies and sexually promiscuous among us, too. We’re no better than anyone else.

It really isn’t an us-them thing. It’s more akin to the feeling of putting a lot of time into –say — painting a portrait of someone and then, just when you had them looking good, having them pull out the can of black spray paint and undoing everything you’d just spent your time and energy on. I think you’re only human if you have the WTF?? reaction.


And actually, put it that way, and I now completely understand where you’re coming from. We can all relate to that!


Thank you!


O.K. I gotta go have a smoke.

Just like WTS’ well done essay on the values of censorship in art yesterday, I disagree with some parts of this post but, boy, it is well done.



Brilliant, Pepe!

For Adonai and others who may see tobacco as no different than obesity as a health issue, here are some interesting stats and perspectives from the World Health Organization that illustrate how tobacco is far more deadly:

Tobacco use kills more than 5 million people per year.It is responsible for 1 in 10 adult deaths.

(At least 2.8 million adults die each year as a result of being overweight or obese.)

Among the five greatest risk factors for mortality, it (tobacco) is the single most preventable cause of death. Eleven per cent of deaths from ischaemic heart disease, the world’s leading killer, are attributable to tobacco use.

More than 70% of deaths from lung, trachea and bronchus cancers are attributable to tobacco use. If current patterns continue, tobacco use will kill more than 8 million people per year by 2030. Up to half of the world’s more than 1 billion smokers will die prematurely of a tobacco-related disease.

The economic costs of tobacco use are equally devastating. In addition to the high public health costs of treating tobacco-related diseases, tobacco users are also less productive due to increased sickness, and those who die prematurely deprive their families of much-needed income.

Tobacco use and poverty are inextricably linked. Many studies have shown that in the poorest households in some low- and middle-income countries, more than 10% of total household expenditure is on tobacco. This means that these families have less money to spend on such basic items as food, education and health care. In addition to its direct health effects, tobacco use leads to increased health-care costs. It contributes to higher malnutrition and illiteracy rates, since money that could have been used for food and education is spent on tobacco. The role of tobacco use in exacerbating poverty and hindering economic development needs to be fully recognized.

Another key difference, some of the conditions connected to obesity such as diabetes, high blood pressure, etc. can be treated, reduced or reversed through non-intrusive, simple treatments and in some cases, just a change in behavior.

None of the diseases from smoking, such as cancer and heart disease can be so simply addressed or reversed.

Still, obesity is an epidemic worldwide, it is no longer a condition only of the more affluent nations, it is growing across many nations at every income level.

So, we are talking about Deadly and Deadlier here. Obesity is a major killer of people but tobacco is almost twice as deadly, in a poisonous league head an shoulders above even the number two killer of human beings.

Haruko Haruhara

Actually, another thing that no one has mentioned is that a lot of recent research is strongly suggesting that tobacco is a major risk factor for diabetes.


HH, there are studies that show a link between smoking and increased risk for breast cancer, too.


k’es, I need to step in here with a little anecdotal “evidence.” I have been a smoker/nonsmoker/ smoker and know what the effects are on my blood tests. I have blood tests every three months (sometimes monthly) done at a highly rated research center and the blood tests are sometimes very extensive, down/up to DNA studies. The difference of some of the levels of some “bad stuff” related to heart disease, diabetes, low oxygen, inflammation in muscles and bone joints …….. (I could pull out one of my many results) is starkly different between smoking and not smoking!
Smoking can alter many things most not healthy for any human. Sugars, salts, blood pressure, potassium, iron, lipids, a long list.
Of course that is just me.

The research docs and staff tend to believe I am not unique, but what do they know? 😉
I also know that long term poor health is not fun-at all.
’nuff said.


b’ito, this is the reason for my passion on this. I realize I have not minced words tonight.

But believe it or not, it’s because I do care about my patients that I feel strongly about quitting smoking.

I don’t “hate smokers,” as has been implied tonight. I hate cancer. I hate emphysema. I hate cigarettes.

And you’re right, long term illness is the pits!


Hmm. Interesting to note.


AdLib, The health issues and all that don’t really bother me to be honest. Though we do many unhealthy things I just wonder why smoking is always picked on.

If people choose to smoke, knowing it may kill them, how is that a problem? Who am I to ordain how another will live their life?

And stopping smoking involves a simple change in behavior too. Just saying it’s hard to quit is no justification to not quit. I heard that for years from my brother’s wife. But one day she decided to take it seriously and she quit. As did many many other people I know. It’s like calling alcoholism a disease. it isn’t a disease. Just stop drinking. No matter how you parse it, it really is that simple.

Same with the bad food we eat and the lack of exercise and all that. The only one standing in the way of change is ourselves.


First, I am libertarian about personal behavior for the most part and I agree that if someone wants to smoke, they should be allowed to.

I do think it’s easy to be carefree about the long term risks of doing something earlier in one’s life that aren’t currently having a detrimental impact. Either way, one’s attitude about risk doesn’t increase or decrease it’s likelihood, unless of course it modifies risky behavior.

Scientifically, it can be proven that it is absolutely not a simple change in behavior that can end nicotine addiction. Biological addictions, as opposed to emotional addictions can not, in a great deal of cases, be ended without a degree of time, treatment and/or difficulty.

Anecdotal evidence isn’t definitive (though I’m pleased to hear your sister-in-law was able to kick cigarettes without difficulty). Alcoholism is also physically addictive to those that have a certain physiological condition.

Just because one person doesn’t get pregnant doesn’t mean other people don’t. In your case, perhaps you could quit cold turkey tomorrow if you wished. That doesn’t mean that other people don’t have physical conditions that cause their bodies to go into severe withdrawals when nicotine or alcohol levels in their systems are reduced.

You should be pleased if you’re not one of those people while also understanding that Fate could have dealt the cards differently and you could have been. If that was the case, I think you would appreciate if others didn’t regard you instead as lacking in will or self-restraint.


Adonai, alcoholism is a symtom of deeper psychological issues and should not be treated lightly. It is an illness, and a deadly one. You cannot simply pull yourself up by your bootstraps. Some heavy drinkers have done it, but being a heavy drinker does not necessarily mean you are an alcoholic. Believe me, I know what I’m talking about.


Adonai: let me weigh in on this. It’s very late, this is my first “stop” here today, and I am tired. But what I have to say is important, I think. At least it’s my POV.

I am 59 years old. I have never smoked a day in my life. Each of my parents smoked 2 packs/day until they died, both from lung cancer (my dad from adenocarcinoma from working in a shipyard and smoking, and my mom from oat cell carcinoma, only caused by cigarettes).

They left me an orphan at age 37. They also left me unable to ever scuba dive because I have a bleb on my lung due to growing up in a home and riding in a car with smokers. I have had my lung collapse three times. They would NEVER have caused me harm knowingly. I would give almost anything to be able to dive, as snorkeling is the closest to heaven I will likely ever get.

I would drive 4.5 hours each way, each weekend, to go home to see my dad when he was dying. It took six months. He had given up cigarettes years before, gained 15 pounds, and took up smoking again because he did not want to be “fat” (he was 5’8″ and weighed 145 lb. normal and 160 lb. “fat”). My most vivid memory of this time of his dying was watching him, looking like a Holocaust survivor, eating Ensure and trying to gain 1/2 lb.

Even his death couldn’t make Mom quit. She tried Nicorette, but gave up. So seven years later, she died a very painful and sad death.

Remember how I said above how I would give almost anything to be able to dive? Well, I would give everything to see my folks again. No almost to it.

So….people choosing to smoke hurt others and leave their children (however old they may be) with the image burned in their brain of their tortured and protracted and sad deaths. The deaths would have happened anyway, and maybe even from cancer – but maybe not. And maybe not at ages 65 and 67 respectively.

If they ate bad food and didn’t exercise, they would still die. Everyone does, now, don’t they?

While it may be OK if you are an adult to do as you like, when you are a parent, you owe it to your children to not let them see you kill yourself slowly, no matter the means. You have a responsibility to them.

And that’s just my POV. Good night.


Thank you, AB. That’s all I can say. 🙁


Oh, I don’t see it as equal.

All I’m asking for is a half cent to cent tax on soda, etc. for every dollar taxed on cigarettes.

I don’t know if that’s proper proportionately, maybe it’s a cent to three dollars or far more, but I’m just saying, — my vice may be a helluva lot worse than yours if you eat fast food regularly, but loading all the taxes on one doesn’t seem to me to be anything more than going to the trough of outcasts. The moment “normal” people have to chip in for unhealthy habits that “good” people do, all holy hell breaks loose.

I, for one, have never been trying to push a false equivalency, and I’ve been doing a fair share of devil’s advocacy – self-consciously weak at that – but while I don’t complain too much about it because I know it’s a horrible habit that makes me feel like utter, worthless shit (self-esteem wise at least), I still would like a smidgen less hypocrisy from all the perfect do-gooders who’ve never had a vice (okay sorry, I know that’s not the case, but golly does it feel that way sometimes), that’s all.


Pepe, you know which side of the debate this nurse is gonna be on.

I see it all the time. I see the really sweet people who live on IV steroids, tethered to their oxygen supply, sleeping sitting up every night, totally winded from a trip to the bathroom and back. I see the people (who aren’t quite that far along in the death process) who come in to the hospital when they can’t breathe, get their meds and treatments, and then push their damned IV poles down the hallway so they can stand out there on the sidewalk in front of the hospital in twenty degree weather, in their flimsy hospital gowns, with a sheet wrapped around their bums and smoke!

It’s as though the dialog goes:

On admission==

Them: “Save my life! Save me! I can’t breathe!”

Us: “Okay, let’s go full tilt and give you every treatment we have to save your life!”

Six hours later==

Them: “The hell with you. Just try and make me stay alive. I have a right to smoke, you self-righteous cow!” (By this time they’re in withdrawal and grouchy.)

Rinse and repeat… sometimes every three weeks.

Here’s a suggestion: you do have a right to smoke, folks. And you also have a right to stay home from the hospital when you can’t breathe. I totally respect people who are trying to quit, even when they fail. It’s the ones who want all the treatment, all the meds, all the home equipment, all the disability payments, and have absolutely no intention of even cutting down that get to me. They’re the first ones who will say that the staff at the hospital is “not smart enough” to cure them when they get into trouble.

Two things about cigarette addiction and the way it differs from the food issue. There is no minimum daily requirement for nicotine. No one has to smoke. Everyone has to eat — although I recognize that that does not excuse over-eating — it just makes it harder for the individual to regulate. And smoking is not a victim-less crime. The kids of virtually every smoker I know have asthma. The parents all say that they only smoke outside (except when it’s “really cold”) and not in the car and blah, blah, blah but the kids end up with asthma anyway.

Stay on this issue, please, Pepe! Just because “all of us have vices,” (and we all do, especially me 🙁 ) doesn’t mean we should give up on eradicating cigarettes from the planet.


Kes, I will give you 30 minutes to back track on this.


Sorry, 2CCP! No can do! It comes from many years of nursing experience.


Kes, I know no children of smokers with health problems. And I know many smokers.

There is no established scientific data backing up ANY claims of the dangers of second hand smoke.

And refusing treatment at a hospital because they choose to smoke? My mom is a nurse and a smoker. She would have strong disagreements with much of what is written here.


First off, I totally do not believe in refusing treatment to smokers at the hospital. And I never said that. I’m just wondering why people who have no intention of ever quitting feel that they should go to the hospital and be resuscitated repeatedly.

I’m not saying “no code,” but if people say they think it’s not important to reach the age of 80, that “no one lives forever,” then they need to remember what they said when they get into trouble.

Of course, I’m gonna take care of them when they get there and do a good job of it, too. And I won’t even lecture them. I never do. But in my head I’m thinking: “You really do want it both ways, don’t you? You want want you want. But you don’t want to suffer any consequences either.”

After a while it gets exhausting to be the human standing between someone who’s made a bad choice and all the possible consequences of it. But it’s part of my job and I do it and I don’t make people feel guilty about it either. When someone is turning blue and gagging on her own mucus is not the time to lecture.

As for your claims about second hand smoke, all I can tell you is that just about every pediatrician on the planet would strongly disagree with you. And I’m happy that there’s a little pocket of KY where no children of smokers have asthma, but that is most definitely not the case around here.


Every pediatrician in the world has been repeating the old saw about 6 to 8 glasses of water per day, but there’s no basis for it.


I never met a pediatrician who recommended that… but even if some doctor somewhere was once wrong about something, it doesn’t mean that every doctor everywhere is wrong about everything.


Kes, I understand that but I don’t believe everything I am told just because an “authority” told me so. They are wrong, often.


So, you would rather they stay at home and suffocate?


I would rather they not come to the hospital and smoke.

And playing the victim card might be psychologically satisfying to them, but their lungs didn’t get the memo.


kes, on the subject of tobacco and nicotine addiction, hospitals and other health care organizations have to be the biggest hypocrites in history.

Let me show you how this works. You are a nurse, working in the admissions area or the emergency room.

First patient you greet is a heroin addict. You assess his or her health, get him or her medical attention, and do an assessment for admission or referral into a treatment program. Depending on a few factors, you would expedite admission into a detox program, give the addict loads of referrals, and even possibly call the hospital chaplain in to talk to him or her.

Second patient is an alcoholic in medical distress. You assess his or her health, get him or her medical attention, and do an assessment for admission or referral into a treatment program. Depending on a few factors, you would expedite admission into a detox program, give the addict loads of referrals, and even possibly call the hospital chaplain in to talk to him or her.

Third patient is a smoker in medical distress, directly related to their smoking habit….

So, and I am being as charitable as possible here, you get the patient breathing treatments, possibly oxygen and anti-inflammatories, etc. If you are like most hospitals, you’ll refer the patient to a state-run “smoking cessation program” which is little more than business envelope filled with a bunch of crap literature, a local “group therapy” session that has never been shown to offer any real benefit at all, and, if the patient is really lucky, a $5 coupon off a $80 box of nicotine patches (which is only the first week of a six-week course of nicotine patches).

Really? Do you really want to go with that?

Do you realize that nicotine addiction is currently treated *worse* than crack addiction? If a crack addict comes into an ER, they are treated like someone with an addiction. If a smoker comes in, they are treated like they are the *origin* of the problem, shut the hell up, and don’t smoke within 20 feet of the building.

Meth, heroin, crack, cocaine, etc., those are *real* addictions. Smokers? The way smokers, even ex-smokers sometimes, are treated by health professionals is disgusting and reprehensible.

Health professionals don’t look at smokers at addicts. They look at smokers as criminals.

How much taxes are states taking in right now off tobacco taxes? I can tell you, it’s a lot. I watched California raise the per-pack tax on cigarettes four times in three weeks.

Supposedly, that tax is paying for health care, to offset the health care issues caused by smoking. Yeah, right. Tell me another fairy story.

I do not know of a single state whose “stop smoking assistance” programs offer any real chance of quitting smoking. Support groups? Bull shit. Been there, done that. The most the state will spring for is printing off useless literature that would put Pollyanna into a diabetic coma.

As far as offering Chantix, Welbutrin, the patch, or anything that might offer a better chance of actually quitting, that’s not worth it. yet we can give Methadone to heroin addicts (and what’s the recidivism rate, even with Methadone?), we can offer addicts and alcoholics de-tox and residential treatment centers.

Yeah, I am really impressed. Great “standard of care” there.

I am very disappointed in you, Kes.


I’d be disappointed in me, too, if that scenario and the health care worker you described were me, 2CCP.

Your theory that every other addiction besides smoking gets taken seriously and given kid-glove treatment is oh-so-wrong. There’s not enough money, resources and facilities to get other types of addicts into rehab or treatment, I’m sorry to say. Especially residential treatment! Not in this rust belt city, anyway. As an acute care hospital we are swamped with the responsibilities of just keeping people breathing. If our ER were saddled with the additional responsibility of arranging detox and in-patient rehab for every patient who needed it, we would need 50 social workers and a billion dollar grant. We treat the most acutely ill and we have to triage.

If Chantix, nicotine patches and group therapy don’t work, what are we supposed to do? Lock people up without access to cigarettes for six months and hope there’s no recidivism when they finally get out? There’s no magical way for the health care profession to accomplish the feat of nicotine withdrawal.

Neither I nor anyone I know has ever treated a smoker as a criminal. But when someone is in the hospital for respiratory distress and is literally pulled back from the brink of death, and then goes out to smoke, am I supposed to smile and say: “Well, isn’ that jes’ precious, darlin'”? Especially when they show up in the ER at least once a month!

Alcoholics– we do a two to three day detox on them because they have to be weaned off off acute intoxication with IV Ativan. After that, it’s either off to the psych unit or out the door. Sorry, but that’s the reality.

In the current health care environment it’s brutal. I don’t deny that. But the people who work in the system didn’t make up the rules. We have big insurance, big pharma, the Republicans and the Tea party to thank for those. Be disappointed with them.

They’ve stretched us all to the limits. I would challenge anyone to spend a couple hours in the average ER or medical unit. You will see people going absolutely top speed for hours at a time. And when patients decide that they’re going to undo the labor that you put into keeping them alive…

you’re disappointed.


I didn’t say every hospital should run a treatment program. I know better than to even suggest it. I was a substance abuse counselor in the late 80’s, when every idiot with a business plan was trying to open up a treatment center.

But you would refer an addict to a treatment program, or a clinic, or to a detox elsewhere in the city.

What the smoker gets is a flimsy business card, printed with a toll free number and the promise to help him or her quit.

State-run programs do *not* furnish patches, chantix, or anything else, Kes. And I suspect you already knew that.

Go ahead, call the toll-free number that is supposedly paid for with those cigarette tax dollars. Tell them you want to quit smoking. See what you get.

Weigh the envelope of useless literature. There is not a single valid coping mechanism in the whole pile of sugar-coated bullshit.

I have seen virtually every kind of detox, spin-dry, in-patient and out-patient treatment program out there. I have seen methadone clinics. I know how much they cost to run.

I also know how often an ER nurse hands out a referral to those programs. I know how often those programs get called, in the middle of the night, to come do an “emergency assessment”.

Yes, health professionals do treat smokers different than other addicts. You said as much. You look at the others as addicts. You look at smokers as the cause of their own problems. And addicts have, at least, a chance to get better, don’t they? Smokers will always be guilty of having been smokers.

It’s okay, nobody ever promised me forgiveness for the sin of smoking.

I just came from my partner’s doctor appointment. The “behavioral health” consultant asked us if we had any addiction issues, and then if we smoked.

If I had said I was a meth addict, she would have cuddled in me in her lap. When I said I was a smoker, she treated me as being unworthy of being stepped on.

She too, repeated the same lie that the state program would pay for nicotine patches. I hear this in every state I go to.

Washington no longer provides eye glasses, no longer pays for health services received as part of a school special education program, or any form of hospice care. But they pay for nicotine patches?

No, Washington doesn’t. They send a $2 coupon with the usual pile of useless literature (which, by the way, is often donated by firms hired by the tobacco companies).

The health professions will always need scapegoats to sneer at. I’ve been part of that group before, being part of a different group this time is no big deal for me.

I just wish it didn’t remind me of sitting on a bust stop bench at 2:30 a.m., doing a substance abuse assessment on a young man the ER was too afraid to help.


Clearly, 2CCP, you know much more about what I do, how my workplace operates and even how I feel than I do. So there’s not much point in my trying to clarify any of those issues, even though what you just described above is 180 degrees the opposite of everything that I live and work with every day. I am only left with the option of saying that you are completely wrong about nearly everything regarding my own circumstances and leave it at that.

As far as your own feelings go, I trust that you are the expert in that department. Clearly you have a very low opinion of the health professions and for all I know you may have had enough negative experiences for that to be entirely justified. I would never claim that there are no assholes in health care. There certainly are. I am a bit sorry that a guy as smart and funny as you thinks I am one of them. But you’re entitled to your own opinion on that one, too.

I am confused, though, I must admit, on what you feel would be an acceptable treatment program for smokers. Again, I ask, if Chantix, group therapy and nicotine patches are worthless — please, I’m serious here — tell us what works. What program for smokers do we refer people to? I know of nothing in this area that does not involve group meetings, Chantix and/or nicoderm. Is there something I haven’t heard about?


Pepe, how can it be murder when people willingly use cigarettes? There have been warning labels on cigarette packages for at least 45 years. I just don’t get the argument that tobacco companies are responsible for the death of people when those people use tobacco willingly, even after being warned of the dangers.


KT, I guess I would see it more as assisted suicide.

Big tobacco has a product that is both addictive and lethal in a high degree, and it refuses to take the product off the market. Granted, people — actual individual humans — light up the cigarettes. But it’s like handing a gun to someone who is suicidal, I think.

The person who supplies the weapon bears at least some responsibility. Which doesn’t completely let the smoker off the hook, though.


kes, yeah I can see your point. But smokers aren’t suicidal. Many smokers hope that they will not get cancer or emphasema. They are rolling the dice. Many people who smoke do not get cancer or develop lung disease. My great grand dad smoked unfiltered cigarettes and drank whiskey his entire adult life, and he lived to be 86 years old, and died of a heart attack. So, it is, to some degree, rolling the dice.
And there would be a huge problem trying to keep people from smoking. It would be like the war on drugs, but much larger. I say, let people choose for themselves.