FOR YOUR OWN GOOD - The Anti-Smoking Crusade and the Tyranny of Public Health, by Jacob Sullum,338 pages, $25, ISBN: 0-684-82736-0, The Free Press, New York, 1998.

Review by Del Meyer, MD

Jacob Sullum, Reason Magazine, editor and featured speaker at the Banquet of the 55th Annual Meeting of the Association of American Physicians and Surgeons in Raleigh, North Carolina on October 10, 1998, spoke on "Doctor's Orders: How Public Health Lobbyists Prescribe Morality." With many Tobacco suits having been settled since Sullum's address, a look at his book is enlightening. On the frontispiece, the author quotes former Surgeon General C. Everett Koop: "1984: I believe the ultimate goal should be a smoke-free society by the year 2000; 1996: From my point of view, anything that stops smoking is good." The second quotation, though disturbing, lends perspective to the issues Sullum discusses.

As conference participants noted, most physicians are to the right of center, while many of our leaders and administrators are to the left of center. Unfortunately, because those left of center often prejudge the motives of those right of center, a reason based discussion becomes difficult. Sullum's book deals with principles and he asserts that even when the goals of both sides are identical, those on the left see the issues not as a matter of principle, but of expediency. Those on the right perceive the efforts of those on the left to try to rescue tens of millions of smokers as an exercise in tyranny that resorts to censorship, punitive taxes, and violations of property rights.

Sullum begins by pointing out the prejudices inherent in the voice of reason. He works for Reason magazine, published by Reason Foundation, a think tank to which Philip Morris Companies contribute. Although the Reason Foundation does not support tobacco research, and tobacco contributions are less than 1% of the revenues, Sullum has been accused of being in an industry-financed conspiracy to undermine the anti-smoking movement. Some refer to "Mr. Sullum and his tobacco patrons." How can one prevent all contributions from organizations of questionable merit?

Sullum has learned about his own motives. When only 10 years old, he put up "Thank You For Not Smoking" signs around the family home and hid the ashtrays his parents had for their guests. Years later he realized that he had not been concerned about the guests' health-- he was on a power kick based on moral superiority.

Sullum's next self-realization came after giving up his crusade for a smoke-free society. He began to understand that freedom to make choices comes from accepting responsibility for the consequences of one's actions, agreeing with John Stuart Mill that the only time a person should be made to do something against their will, is when their action harm others--"his own good, either physical or moral, is not a sufficient warrant."

Sullum takes us on a journey from the Devil's Weed, to the soldier's friend; from Christopher Columbus's introduction to the dried leaves of the Arawak Indians to the Puritans of New England who were so against using tobacco as an intoxicant that Massachusetts banned tobacco sales and smoking in public in 1630. Although these laws were not seriously enforced and some were repealed, the spirit continued through such avenues as ministerial students being warned about slavery to the pipe. Then in 1869, the F. S. Kinney and Company of New York produced the first cigarettes in the US. By 1881, James B Duke's family's tobacco company, destined to become the huge American Tobacco Company, began making cigarettes. In 1924, James Buchanan Duke created Duke University, a tobacco-free institution that, nevertheless, uses tobacco money to research how cigarette chemicals insidiously damage developing brains.

As a pulmonologist, I make my living caring for people dying from their cigarette habits. Although at least 80% of the 27,000 patient I have seen in my practice in 29 years have cigarette-related illness, I have never told a patient to stop smoking. My job is to explain to my patients, as vividly as possible, what they are doing to their lives and health with their habits and that dying from cigarettes is a most suffocating experience--harder on loved ones than themselves. I have been more effective in getting people to stop smoking than those who play Moses and hand their patient the eleventh commandment: Thou shalt not smoke cigarettes!