For Your Own Good: The Anti-Smoking Crusade and the Tyranny of Public Health [BARGAIN PRICE] (Hardcover)

Jacob Sullum has written For Your Own Good in homage to the decision-making rights of the smoke-seeking species, if not necessarily its decision-making prowess. Sullum's core message is evident in the book's subtitle, The Anti-Smoking Crusade and the Tyranny of Public Health. He argues that the government, urged on by an overly zealous public health community, has gone too far in protecting smokers from themselves, and the rest of us from smokers. Drawing on the wisdom handed down by a long line of liberal philosophers, Sullum concludes that government's only legitimate role with respect to smoking lies in prohibiting harms to others. These harms, if they exist at all, are modest, he believes. His two-pronged argument against government intrusion thus rests on a factual predicate -- that smoking is primarily a self-affecting behavior willingly engaged in by knowledgeable adults -- and a philosophical proposition -- that individualism trumps a communitarian approach in defining the welfare of society.

A curious and challenging mixture of fact and philosophy is what makes this book so intriguing and worthwhile. Sullum marshals an impressive array of facts and arguments in tackling such fundamental issues as addiction, the risks of exposure to environmental tobacco smoke, the legitimacy of taxing cigarettes, and the effects of advertising. He has undertaken a truly prodigious amount of research and frequently (but decidedly not always) demonstrates a striking sophistication in discussing technical issues. The history he presents is consistently accurate, and his enumeration of arguments for and against various propositions often exhibits a scholarliness not always found in the work of tobacco-control researchers. Smoking-and-health cognoscenti stand to learn something, both substantive and tactical, from the specifics of the arguments and the manner in which they are crafted.

If the enumeration of arguments is scholarly, the interpretation is often less so. Sullum's take on any number of issues is invariably anti-anti-smoking, colored to a deep hue by the driving force of his philosophical concerns. (He is neither pro-smoking nor pro-industry. He readily acknowledges the dangers of smoking and criticizes the behavior of tobacco companies repeatedly.) He exhibits little appreciation of addiction, dismissing it by resorting to such bromides as the fact that a large proportion of smokers has successfully quit without formal assistance (the same is true of heroin addicts) and such sophistries as the fact that some smokers will quit smoking or reduce daily consumption in response to an increase in the price of cigarettes. (Drug-addicted laboratory animals do exactly the same when the "price" of their drug -- the number of times a lever must be pushed, for example -- is increased.) Sullum is not concerned by the youthful initiation of smoking, in large part because he does not accept that smoking is truly (and importantly) addictive.

Sullum also occasionally relies on dubious sources. To demonstrate that smokers appreciate the risks of smoking, he cites a survey finding that people overestimate the risk of dying from smoking-related lung cancer. Performed for the defense in a product-liability case brought against tobacco companies, the survey was designed to elicit this response. He ignores much of the more substantial body of evidence that smokers underestimate the risks of smoking. Sullum's interpretation of the crucially important evidence with respect to the health implications of exposure to environmental tobacco smoke is similarly one-sided, revealing a limited appreciation of the science and drawing on the opinion of economists at the Congressional Research Service that the epidemiologic evidence linking such exposure to disease was inadequate.

Sullum is better on other issues, such as the impact of advertising, where cause and effect remain controversial. On this subject and others discussed in the book, I found my own appreciation of the evidence enhanced by reading Sullum's interpretation. It is the many such instances that make this book educational and of particular value to readers familiar with the smoking-and-health story. Others, unfamiliar with alternative interpretations of the evidence, are at risk of being "snowed" by Sullum's eloquence.

Given Sullum's monotheistic adherence to rugged individualism (those opposed to smoking are not the only ones on a crusade), you might be tempted to dismiss For Your Own Good as but one more libertarian screed. Don't. Sullum is a thoughtful and remarkably articulate proponent of a position that it behooves all members of the health care professions to understand and contemplate. Our attempt to elevate community health to a preeminent place among American values often conflicts with our society's emphasis on individual liberty, even -- perhaps especially -- the right to make risky or unwise decisions. Sullum fears that the latter value -- one that I view with considerable respect -- is in danger of being swamped by a tidal wave of "health Nazis" (my wording, not his). In a corporate culture that has made the Marlboro Man one of the most widely recognized symbols in the world, one might readily conclude that it is the public health troops who are at risk of being submerged.

Reviewed by Kenneth Warner, Ph.D. --This text refers to an out of print or unavailable edition of this title.

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