Should cigarettes be illegal?

A proposed bill in Oregon to make the possession of cigarettes illegal is well-intended, but from a practical standpoint, it's unlikely to happen, bioethicists and public health experts say.

The ban, sponsored by State Rep. Mitch Greenlick of Portland, would make nicotine a controlled substance, and says possessing more than 0.1 milligrams would be illegal, punishable by a year in prison or a $6,250 fine. Exceptions would be made for people who had a doctor's prescription for the drug, according to the bill.

Tobacco clearly takes a significant toll on the lives of Americans, causing 450,000 premature deaths each year, and drastic measures should be taken to eliminate the habit from our lives, including, some say, banning cigarettes. But others argue that, in today's society, such a goal is overly idealistic, and would be extremely difficult to implement.

"As someone who's looking out for public health, I think it’s a great thing," said Dr. Bradley Flansbaum, a hospitalist at Lenox Hill Hospital in N.Y. "Knowing that tobacco is public enemy No. 1 in preventive illness...I don’t think I can endorse smoking for any reason," Flansbaum said.

However, "Politically, it's going to be a tough if not impossible sell," Flansbaum said.

In 2009, the Food and Drug Administration banned the manufacture and distribution of flavored cigarettes, such as chocolate and cherry, over concerns that the products encouraged youth smoking. However, banning all cigarette products is a different matter entirely. Barriers to passing such a ban include the power of big tobacco companies, the cost of enforcing such a law, and the rise of a black market for cigarettes, experts say.

"Once you have a substance out there like tobacco in wide use it's hard to turn around and make it illegal," said Arthur Caplan, a bioethicist at New York University School of Medicine's Division of Medical Ethics, "You can certainly tax it, you can certainly stigmatize it," and educate against its use. But ban it? "In reality, it's not going to happen," Caplan said.

"Smoking has been around too long, and the industries that profit from it are huge and will fight to the end," Caplan said.

Rosalie Liccardo Pacula, co-director of the Drug Policy Research Center at the RAND Corp., a nonprofit research organization, said she was surprised to hear of the bill. "The policy would require an enormous cost to enforce if it is to have any teeth, which most states are not in a position to absorb," Pacula said.

However, others argued such barriers should not deter the action.

"That's really the ultimate goal — to have the world free from the death and destruction it causes," said Dr. Amy Lukowski, clinical director of Health Initiatives Programs for the National Jewish Health Center in Denver. "How we do that? That's the million-dollar question." Although anti-smoking policies have made strides in reducing the number of people who smoke, "I think we have to do something drastic about this," Lukowski said. "[It's] taking the lives of Americans every day." Indeed, a study published today (Jan. 24) in the New England Journal of Medicine found that smoking takes at least 10 years off a person's life.

"I think we should try," said Dr. David Katz, director of the Prevention Research Center at Yale University School of Medicine. "What's possible begins with what we try to do. I think there is a strong argument for never allowing another child to become addicted to tobacco," Katz said. "This would never be approved for sale today, and we should get rid of it."

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