Limits of regulation - Federal Regulation of First- and Second-Hand Smoking

First-Hand Smoking
With the failure of alcohol prohibition in mind, skeptics doubt you could prohibit smoking. You might be able to regulate it by having it only sold in drug stores or by prescription. Either way, it would likely invite contraband sales and a booming underground economy dealing with cigarette sales.

In a thoughtful NEJM piece, Harvard health system history of medicine professor, Dr. Allan Brandt, says, “The regulatory status represents one of the most paradoxical stories in American medicine and public health; the single most dangerous legal product in U.S. consumer history has eluded virtually all federal regulation until now.”

He clearly believes an FDA bill now before Congress,which stresses cessation and prevention and scientific assessment of new products is a good thing. He feels trrying to reduce the prevalence and minimize damage of cigarettes through federal law is worth debating because one of five Americans still smoke, 430,000 deaths occur annually as the result of cigarette use.

Second-Hand Smoking

Illnesses related to second-hand smoking has always been debatable in some quarters. But there is a powerful movement at state, local, and federal levels to ban smoking from public gathering places, public buildings, and restaurants.

Now evidence from Scotland, which introduced legislation prohibiting smoking in all enclosed public places and workplaces after the end of March 2006, indicates the incidence of hospitalization for acute coronary syndrome dropped sharply in a ten month period after the legislation compared to the ten month before.

Overall, number of admissions dropped 17%, as compared to a 4% reduction in England, which had no legislation.

Authors of a July 31 NEJM article, from the University of Glasgow, conclude,

“The number of admissions for acute coronary syndrome degreased after the implementation of smoke-free legislation. A total of 67% of the decrease involved non-smokers. However, fewer admissions among smokers also contributed to the overall reduction.”

A poet writing for the Scots might write,

Where there’s second-hand smoke,
There are fewer heart attacks,
That’s no joke, blokes,
Those are the facts.

References

1. A.M. Brandt, “FDA Regulation of Tobacco – Pitfalls and Possibilities,”New England Journal of Medicine, pages 445-449, July 31, 2008?
2. J.P. Pell and others, Smoke-Free Legislation and Hospitalizations for Acute Coronary Syndrome,” New England Journal of Medicine, July 31, 2008.
3. Pages 482-491, July 31, 2008.