And, slowly but surely, smoking is becoming less popular. Just like drunk driving before it, smoking is becoming socially disreputable. It’s a long, hard road, though: not just because nicotine is addictive, but because youngsters continue to take up smoking despite the social stigma increasingly attached to it.Sometimes they smoke because of, not despite, that social stigma. Sometimes they want to rebel against social control.
the battle to protect youngsters from taking up smoking is one that virtually all adults, smokers or not, support.This is a political position which is nowhere near universal. Not everyone thinks children should be "protect[ed]" – meaning controlled supposedly for their own good. Some people value the freedom to smoke, and the freedom of individuals (even young individuals) to choose their own fate. Some people see some value in smoking (e.g. South Park has defended smoking). Some people think children should be helped to become more wise, rather than protected. Maybe good advice and control over their own lives works better for children than protection. There are diverse approaches to this topic.
Similarly, not everyone agrees about addiction. I don't.
Approaching issues by saying everyone agrees is a bad approach in general. Look what would happen with SENS and aging. People would say virtually everyone disagrees with SENS, so it's bad. The same tactic could be used against most innovative new ideas, early on.
with smoking, even though it causes some of those self-same diseases, somehow society is itself subject to an addiction that robs it of its rationality concerning new young addicts. We face every day the brutal disconnect between allowing cigarettes to be advertised and sold widely and seeing how much they blight and shorten the lives of those who fall under their spell.Rather than argue with people who disagree with him, here Aubrey de Grey attacks their rationality and metaphorically accuses them of a mental illness (addiction). He then attacks free trade and free speech, as if his positions against those things are uncontroversial and need no explanation. (Saying a product is good is speech; selling it is trade. Disallowing those things is incompatible with freedom.)
People who disagree with you are not mentally ill. They have not fallen under a magic "spell". People are capable of thinking and disagreeing with you. You should expect that and speak to the issues, rather than gloss over the issues (no direct criticism of freedom was provided) and spend your time denying the other side exists. Try to find win/win solutions which address people's concerns. Persuade people instead of calling them mentally ill, irrational, or otherwise talking around their arguments.
It'd be better to approach this like David Deutsch: "in every human dispute there’s a substantive issue at stake". Calling the other side mentally ill does not help anyone better understand the substantive issue at stake. Claiming (correctly or not) that one's position is popular, or creating a social stigma against things one disagrees with, are not truth-seeking approaches.
Re: Aubrey de Grey Vs. Smoking
You make a fair point concerning the language I chose. However, I stand by the last sentence you quote (about the brutal disconnect). Society's policy concerning cigarettes, whether right or wrong, contrasts very starkly with its policy concerning other products that are (or are even suspected to be) similarly harmful.
The Costs of Smoking
Let me chime in there and note that US policy on smoking is certainly irrational if the goal is to lengthen healthy life as much as possible per dollar spent on disease and early death. In what follows I’ll simply forget the problem of aging and aging research, and keeping with the simple disease model, note that we wildly under-spend on smoking cessation.
The fact is that smoking is the #2 cause of death in the US, just behind cerebrovascular disease (of course these categories change if you split out heart disease from stroke, etc. For convenience sake I’ve rolled them into one).
In the US we have about 2.5 million deaths a year, and 616,000 are from heart disease and 134,000 from stroke, and that gives about 750,000 cardiovascular (CV) deaths total. But 22% of these are from smoking in North America:
So total non-smoking CV disease is only 585,000 per year.
The total smoking-attributable death toll in the US is 480,000 per year, or about one death in 5. Here I count smoking cancer, smoking CV disease, smoking lung disease—all of it.
Cancer? It’s 585,000 deaths a year in the US, but 30% of cancer deaths are due to smoking in the US. So it’s really only 409,000 non-smoking cancer deaths, which puts it down to #3 cause.
To sum up, we have:
#1 Cardiovascular disease (nonsmoking) deaths per year: 585,000
#2 Smoking deaths: 480,000
#3 Cancer (nonsmoking) deaths 409,000
#4 Everything else: 1,026,000
If we were going to spend money wisely, we would attack these causes of death in rough order of the people they kill, or at least the number of years of life lost. For smoking, the average smoker loses about 10 years of life, but only 20% of adults smoke in the US, so I would guess that if we got rid of all smoking (switched everybody to other nicotine delivery systems) we would gain 2 years of life expectancy for the country. This is (coincidentally) about the same as we would gain if we cured all cancer, somehow having totally won that war.
Do we do it that way? Oh, my, no. The National Cancer Institute (NCI) at the NIH gets more money than all the other institutes, with NCI pulling down $5 billion a year out of about $30 billion NIH total. By comparison, the NHLBI (heart, lung, blood institute) gets just $3 billion. But NHLBI diseases (mostly CV) shorten US life by at least 10 years. That’s the ratio by which people fear cancer more than heart disease and stroke—about 5/3 * 10/2 = 8 times more.
Well, they are privileged to think of cancer that way—who am I to say? But not all heart attack victims die quickly, and stroke can be gruesome, so I have the feeling that the ratio here could use some adjustment. Most people don’t know how little cancer impacts life expectancy.
What about smoking, which kills more people than cancer, and just less than all CV disease? And is about as bad as non-smoking related cancer when it comes to overall shortening of national life expectancy (but only because 80% of people don’t smoke)?
Well, I haven’t been able to find the amount spend on state and government antismoking campaigns, but it looks to be in the range of a paltry few hundred million a year. Compare with the $5 billion for cancer research and $3 billion for CV research just at the NIH. There IS NO ANTI SMOKING institute at the NIH! Incredibly, there is an NIAAA, which is the National Institute on Alcohol Abuse and Alcoholism at the NIH. Yes, they get about half a billion a year to do sociology and make alcoholic monkeys. The number of deaths attributable to alcohol every year in the US, including 10,000 a year on the highways from drug drivers? Total is about 90,000. This is pretty bad, but it’s still only 1/5th that for cigarettes. And yet the alcohol people have their own NIH institute and budget, and at $500 million a year, it exceeds the entire amount of all the antismoking campaigns in the entire country, so far as I can tell.
Why is all this a fact? Dang if I know. It’s a matter of history and money and the power of the tobacco lobby ($17 million a year). Tobacco is a $2 billion dollar a year revenue industry in the US, so they can afford it. But that $2 billion results in $8 billion in just medical costs:
So you can see smokers don’t come close to paying for themselves with tobacco taxes, etc. If you’re going to get all libertarian about it, tobacco products would have to cost FIVE TIMES more than they do, to pay for just the medical damage. Or else we’d have to let smokers die in the street and not let them have any Medicare or Medicaid money.
So, to sum up, we have 20% of total deaths in this country result from smoking in the US, but only 16% of total deaths are from non-smoking cancer (I split them out so there is no overlap). Smoking kills more people in the US every year than non-smoking-related cancer does. Yet we have a war on cancer, and spend many, many times more of our research money on cancer than stopping people from smoking. We spend more money researching alcoholism than smoking, even though the smoking death toll is 5 times worse than for alcohol, at least..
Yet, we could win 30% of the war on cancer immediately, just simply by getting every smoker on e-cigarettes or vaporizers (it seems that nicotine does not cause much cancer). That would cost us only a fraction of treating smoking diseases, which is at least $8 billion as already noted, far more than the $5 billion a year we spend at the NCI on researching ALL of cancer.
As a public health measure, do we do this? No. Is that rational? I say “no.” If you think it is, you must be operating on some premise I’m missing. Elliot Temple, do you want to be spokesman for the opposite view?
Steve Harris, MD
> #1 Cardiovascular disease (nonsmoking) deaths per year: 585,000
> #2 Smoking deaths: 480,000
> #3 Cancer (nonsmoking) deaths 409,000
> #4 Everything else: 1,026,000
> If we were going to spend money wisely, we would attack these causes of death in rough order of the people they kill, or at least the number of years of life lost. For smoking, the average smoker loses about 10 years of life, but only 20% of adults smoke in the US, so I would guess that if we got rid of all smoking (switched everybody to other nicotine delivery systems) we would gain 2 years of life expectancy for the country. This is (coincidentally) about the same as we would gain if we cured all cancer, somehow having totally won that war.
> Well, I haven't been able to find the amount spend on state and government antismoking campaigns, but it looks to be in the range of a paltry few hundred million a year. Compare with the $5 billion for cancer research and $3 billion for CV research just at the NIH.
> As a public health measure, do we do this? No. Is that rational? I say "no." If you think it is, you must be operating on some premise I'm missing. Elliot Temple, do you want to be spokesman for the opposite view?
My view is not opposite in all ways, and I'm not looking to defend the status quo here. But I do disagree.
Cancer is a disease. Medical research is a good thing, though some of the funding choices may well be dumb like you say.
Smoking is a lifestyle choice. Trying to push people to live their lives a differently is a completely different category of activity than medical research.
One is science, the other is authoritarian social control.
You talk of shifting funding from one to the other as if they were the same type of thing.
Figures for things like deaths per year are irrelevant to the major principles involved like freedom. Freedom must include the freedom to live in ways you disapprove of.
In the extreme case, suicide is an important human right. And the option not to use SENS, cryonics, antibiotics or other life-saving medicine is an important human right. So why not smoking?
Many people want cancer cures. They can be effectively offered on a voluntary basis to help people. Many smokers don't want government anti-smoking efforts and regard those as harm, not help.
We're talking about, on the one hand medical research, and on the other hand oppressing an unpopular minority group. These have nothing to do with each other.
> So you can see smokers don't come close to paying for themselves with tobacco taxes, etc. If you're going to get all libertarian about it, tobacco products would have to cost FIVE TIMES more than they do, to pay for just the medical damage. Or else we'd have to let smokers die in the street and not let them have any Medicare or Medicaid money.
I don't think you understand libertarianism. A libertarian would answer that medicare and medicaid shouldn't exist – and perhaps add that the government shouldn't fund any non-military science. No libertarian would suggest taxing tobacco way more as the answer.
The idea that because the government gives handouts of various kinds, it therefore has a right to control people's lifestyles, is an attack on freedom.
The handouts are a form of wealth redistribution by force. That's bad enough already without also using them as an excuse for why freedom can't be allowed.
(I'm not a libertarian, but I agree with these particular points.)
I'm not convinced society's policies contrast, because I'm looking at them in a different way. There is more freedom for issues where people especially want freedom. Weight by number of people who want freedom and how much they care, and subtract for the opposition, then add a LOT of variance. Which policies contradict this view?
In other words: smoking gets better treatment relative to various other things because people value smoking more highly than they value those other things. Which makes sense to me, rather than striking me as a big problem.
People valuing smoking in the first place may be a big problem, but that's a separate issue. (I say "may" because I suspect valuing smoking is mostly a consequence of other problems, rather than a primary problem itself. Which, btw Steve, is another potential issue for anti-smoking campaigns.)