Screening Smokers and Weeding out the Wretched

The wretcheder one is – the more one smokes; the more one smokes, the wretcheder one becomes.

George Maurier (1834-1896)

Smoking is a shocking thing- blowing smoke out of one’s mouth into other people’s mouths, eyes, and noses, and having the same thing done to us.


Samuel Johnson (1709-1784)

January 8, 2012 – Smoking has always been considered a vile, disgusting, wretched habit. What has changed are four things: one, recognition that it causes chronic disease with premature death, eight years before non-smokers, two, it is now socially unacceptable; three, it has become economically unbearable, for the nation as a whole, for employers, and for individuals; four, one cannot smoke at work, in restaurants, or inside or outside public places.

Increasingly, smokers have nowhere to go or do what they have to do to satisfy their habit.

In spite of all this, 20% of Americans continue to smoke. Either we enjoy it, are addicted to it, or accept the consequences. Smoking has become the # 2 New Year’s Resolution, #1 being losing weight, and # 2, by stopping smoking. #1 rarely works, with a 98% failure rate, #2 is only a little better, with 96% failing to shake the weed.

According to a 2010 National Survey of Drug Use and Health, among people who smoked cigarettes a year prior to the survey 4.1% stopped, more women stopped than men, stopping went up with education and income; and cessation rates varied by state, with 6.8% stopping in Vermont by only 1.8% ceasing in South Carolina. Yet smoking is the #1 preventable cause of death and disability.

Some of us are lucky. Given enough incentives, we can stop cold turkey. In my case, these incentives included : 1, being a doctor and knowing better; 2) witnessing hospital wards full of gasping ex-smokers with tracheostomy tubes and oxygen tanks; 3) having a mother die of lung cancer from addiction to Lucky Strikes; 4) being married to a nurse who demanded I increase my life insurance or stop; 5) incurring the wrath of my fellow physicians, who no longer openly smoke; or 6) being considered a socially unacceptable wretch.

Now, from a January 6 USA Today report, “Employers Ban Not Only Smoking But Smokers Themselves “ comes these discouraging words for smokers,

“As bans on smoking sweep the USA, an increasing number of employers – primarily hospitals – are also imposing bans on smokers. They won’t hiring applicants whose urine tests positive for nicotine use, whether cigarettes, smokeless tobacco, or even patches.”

It used to be bad breath, yellow fingers and teeth, burn holes in your clothes, now it is your urine that gives you away.

And last year, two-thirds of employees with 300 or more workers offered smoking cessation programs and 31% of smaller companies did so. And if you don’t stop, 12% of companies with over 500 employers raise your premiums and 24% with more than 20,000 workers do the same. And the new health law requires that new health plans screen adults for tobacco use and provide free top-smoking programs.

Tweet: More employers are screening applicants with urine tests for nicotine, offering smoking cessation programs, & raising rates for smokers.