Tobacco

Health Damage through Smoking

The U.S. Surgeon General claims that smoking kills some 400,000 people annually in the United States. This figure is not a simple fact like the number of homicides or automobile fatalities that one can directly observe. Rather, it is a statistical artifact that must be estimated. The Surgeon General's estimate is derived from a sample the American Cancer Society constructs. This sample misrepresents Americans who have died in several respects: for instance, it is biased toward prosperous and college-educated people who are married and live in urban areas, while it is biased away from people who work in dirty or risky occupations or environments.

In contrast, the National Mortality Followback Survey is a representative sample of decedents. When the Surgeon General's methodology is applied to this alternative sample, the estimated lethality of smoking is reduced roughly in half. The use of death certificates further exaggerates the estimated lethality of smoking, as can be seen by comparing death certificates with evidence obtained from autopsies. Physicians often certify lung cancer as the cause of death among known smokers, even though subsequent autopsy evidence shows that often the smoker died from something else. Moreover, physicians often miss lung cancer in nonsmokers, as revealed by a subsequent autopsy. If all death certificates were checked through autopsy, the estimated lethality of smoking might be reduced by half or even more.

Alternative statistical procedures might thus show that smoking results in about the same death rate as homicides and automobile accidents. These are still large numbers, to be sure, but hardly an apocalyptic pandemic. People who want to extend their life span would surely be well advised to avoid smoking, even though no guarantee could be offered to this effect.

Social Cost and Tobacco Taxation

Whether the lethality of smoking is closer to 400,000 or 50,000 per year, those deaths could be viewed as imposing costs on the remainder of society. Tobacco taxes have increased sharply at both federal and state levels, and much of the support for those increases is based on claims that the health degradation linked to smoking imposes costs on nonsmokers; higher tobacco taxes allow nonsmokers to recover those costs.

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