Kehinde Johnson, Corporate & Regulatory Affairs Director, British American Tobacco (Nigeria) Limited, writing on behalf of Dr. Chris Proctor, of BAT's UK headquarters, fails to respond to the principal questions asked by Professor Simon Chapman of the University of Sydney and editor of the journal Tobacco Control.

In his posting to Tobacco Control's e-letters page, Mr. Johnson relies heavily on the judgment of the Standards Organisation of Nigeria (SON), which has allegedly analysed some counterfeit cigarettes and "confirmed that they have hugely higher levels of tar and nicotine beyond the prescribed limits for tobacco products in Nigeria which constitutes serious health hazards to unsuspecting Nigerians."

First, Mr. Johnson does not specify what "hugely higher" means and provides no scientific basis on which to judge how much such counterfeit cigarettes would increase risk for regular smokers. Second, although the SON website describes its import inspection procedures and explains that it issues "poor quality products reprimands," SON does not post any values for 'safe' tobacco products among its hundreds of Nigerian Industrial Standards (NIS).

The International Agency for Research in Cancer lists the following as carcinogens present in tobacco products: aromatic amines (e.g. 4- aminobiphenyl), polycyclic aromatic hydrocarbons (e.g. benzo[a]pyrene), tobacco-specific nitrosamines, benzene, acrylamide and acrylonitrile. Are these less dangerous when present in what Mr. Johnson terms "genuine brands manufactured in factories under [SON] control and supervision"?

There are also hundreds of known additives to tobacco products, many of which make tobacco products less harsh on the throat and, therefore, easier to inhale, especially for first-time smokers, largely drawn from the youth population. Therefore, could those "hugely higher levels of tar and nicotine" referred to by Mr. Johnson not actually make counterfeit cigarettes less dangerous, rather than more so, by discouraging inhalation?

Mr. Johnson presents no clear evidence on disease risk, one way or the other. He does, however, refer readers to the BAT Nigeria website, where the section on smoking and health allows that tobacco use incurs "real risks of serious diseases such as lung cancer, respiratory disease and heart disease". However, the website information proclaims serious doubts about the worth of epidemiological studies and notes that science has "up till date, not been able to identify biological mechanisms which can explain with certainty the statistical findings linking smoking and certain diseases. Nor has science been able to clarify the role of particular smoke constituents in these disease processes."

First, that is not entirely true, as some smoking disease mechanisms have, in fact, been identified. However, a larger question again goes begging: If BAT and its Nigerian subsidiary have so many doubts about the "lack of complete understanding at a biological level of the disease mechanisms and role of particular smoke constituents [that] creates uncertainty for efforts to design less risky cigarettes", how can the firm criticise counterfeit cigarettes? If you do not deny that thirty, forty or fifty years of smoking will lead to lung and other cancers, plus respiratory and heart disease, nor do you deny there are severe neonatal risks from smoking in pregnancy (though nothing is said about the passive smoking risks from parental tobacco use over much shorter spans), then, again, how much riskier are those counterfeit products? Will they kill more smokers in twenty years rather than thirty or forty? Will they lead to 5.9 million tobacco deaths a year rather than the 4.9 million currently estimated by the World Health Organization?

How exactly are you "working in collaboration with the Nigerian government to support [informing people of the dangers of smoking] through various initiatives" and, finally, when does merely "risky" behaviour become "lethal"? Many lives depend on your answers.

To the excellent article by Bero, Glantz and Ling one may add the classical observation of RE Thornton of BAT about women's smoking behavior (1):

"[G]iven that women are more neurotic than men it seems reasonable to assume that they will react more strongly to smoking and health pressures.... [T]here may be a case for launching a female oriented cigarette with relatively high deliveries of nicotine...."

(1) Thornton RE. "The Smoking Behavior of Women Report No. RD 1410." 12 November 1976. British American Tobacco/ Brown adn Williamson. Bates No. 650008159/8191 (at -8183-3)

I believe that colleges and universities must provide ethical leadership in research development, implementation, reporting and funding (not accept tobacco industry research money or researchers that do). They should not support tobacco industry investment or funding for institutions, seminars or fiduciary requirements. Any and all tobacco industry cooperation or collaboration is irresponsible because of the underlying business motives and practices of the industry, past and present.

While there is a long way to go, I have advocated the following for educational institutions in the Asia-Pacific region:

1. Advocate and institutionalize a policy barring researchers and research units from accepting funding from the tobacco industry or organizations funded by the tobacco industry. 2. Advocate and institutionalize a tobacco free campus including a universal ban on tobacco product sales and use both indoors and out on the campus or at any event with institution sponsorship or co-sponsorship. 3. Advocate and institutionalize divestment of financial resources from the tobacco industry, including investments for academic foundations, scholarship funds, retirement/pension funds and credit unions. 4. Advocate and institutionalize certificate level training on ethical research including requirements/prohibitions on tobacco industry research. 5. Advocate and institutionalize strong penalties for violation of ethical research standards including conducting tobacco industry research.

A March 18th article in the Chronicle of Higher Education in the US pointed out that tobacco companies are promoting smoking to college students and "show no sign of stopping" this practice. Young people deserve better than their institutions of higher learning aiding and abetting tobacco industry promotions, addictions and deaths. It is about time that accountability mean something more than how much money can be made in the short run, at the expense of the wellbeing of the next generation. But are colleges and universities willing to really address the known fraud of the tobacco industry or only pretend they are doing so with opportunistic leadership moves?

My position in this debate, which has been a difficult one for the tobacco control community, is that I neither condone nor condemn hiring policies that favor non-smokers. However, I do support the employer's right to adopt such a policy if the employer so chooses. I believe this position—which is intermediate between the opposing views espoused by Nigel Gray and Simon Chapman—is the most appropriate and defensible position for tobacco control advocates to articulate.

Many years ago the tobacco industry was lobbying forcefully in the United States for passage of state laws banning employment discrimination against smokers. From 1989 to 1993, 25 states enacted such "smokers' rights" laws. Malouff et al published an analysis of those laws in TOBACCO CONTROL in 1993,[1] and these authors provided a nice summary of reasons why some employers might wish to hire only non-smokers:

"Why would anyone prefer to hire non-smokers? The answer may differ from organisation to organisation and supervisor to supervisor. Some possible reasons include evidence that smokers as a group have more job accidents, suffer more work injuries, and create more disciplinary problems at work than do non-smokers; a desire of some companies to avoid worker compensation claims for lung damage that could be due to either smoking or an occupational hazard, such as fighting fires; a desire for physically fit employees, for jobs such as police officer and firefighter; a desire to avoid the appearance of hypocrisy, when a smoker works in a job to prevent or treat dependence on nicotine or some other addictive substance; a need to maintain a super-clean workplace free of even the tobacco on the breath of employees; the higher cost of employer-subsidised life, health, disability, and worker compensation insurance when some employees are smokers; the belief that smokers take more sick leave; the fear that occupational toxins such as asbestos may interact with smoking (even if limited to off-work time) to increase risks among employees; and the desire of some religious organisations to hire employees who follow off-work the non-smoking tenets of the religion. Also, the US tradition has long been one of employment at will, meaning that employers can hire and fire whomever they like for whatever reason they want. For instance, employers might choose to hire employees who are relatives, who look or act a certain way, or who seem to desperately need a job. A major limitation on this employer freedom in modern times has been a series of federal and state civil rights laws that prohibit employment discrimination based on race, sex, age, and disability." (citations omitted)

As noted by Malouff et al, the US Constitution and federal and state civil rights legislation protect against discrimination based on race, ethnicity, gender, age, and disability. To accord smokers (as a class) the same level of protection against discrimination, as "smokers’ rights" laws do, would be dangerous in my judgment.

Simon Chapman dismisses Nigel Gray’s argument that smokers are less productive (as a class) than non-smokers, because "many smokers do not take extra sick leave or smoking breaks." However, "discrimination" based on class averages may be justifiable when measurement of individual behavior or risk is impractical or impossible. For example, I pay much higher automobile insurance premiums because I have two teenage sons who drive, even though they may (theoretically) be the best drivers around. Installing alarm systems and smoke detectors in homes reduces premiums for homeowners’ insurance, even though some people don’t use or maintain these devices after installation. Insurance companies assess risk and develop fees based, in large part, on actuarial data and aggregate experience. Employers may wish to use the same approach. It is more practical for employers to refuse to hire ALL smokers, than to refuse to hire only smokers who have worse health or higher risk of disease.

In defense of his position, Simon offers the analogy that employers might refuse to hire younger women because they might get pregnant and take maternity leave, and more time off later to look after sick children. In the US, that policy would constitute illegal discrimination based on age and gender, and would violate the spirit (if not the letter) of the federal Pregnancy Discrimination Act.[2] The analogy is further weakened by the fact that age and gender are inborn and immutable characteristics (except for transgender surgery), whereas smoking is neither. Yes, of course, smoking is addictive; but effective treatments exist and millions of smokers have been able to quit.

Simon also presents a "slippery slope" argument that "employers might ... draw up a check list and interrogate employees as to whether they engaged in dangerous sports, rode motorcycles, or voted for conservative politics." A philosophy professor has called this type of argument an illegitimate application of reductio ad absurdum.[3] Yes, all manner of discrimination in employment occurs today, and will occur tomorrow, but most of that discrimination is sub rosa. A restaurateur may not hire waiters with purple hair and pierced lips, even if those characteristics aren’t mentioned in the company’s employment manual. The issue at hand, though, is EXPLICIT "discrimination" spelled out in corporate policy. Weyco, Inc, a health-benefits management company based in my home state of Michigan, informed its employees about the company’s new "smoker-free" workplace policy 15 months before implementation.[4] It’s hard to imagine widespread adoption of similarly announced hiring policies based on Simon’s example of political ideology. (A rare exception might occur when such ideology is central to the job’s responsibilities—for example, editorial writers for conservative newspapers.)

Another problem with this "slippery slope" argument is that it implies—wrongly, in my judgment—that employers cannot be trusted to adopt hiring policies based on a careful consideration of the merits and demerits of each policy option. A health insurer may decide to "discriminate" against smokers—and smokers only—for reasons outlined by Malouff et al.[1] The National Basketball Association’s standard player contract prohibits motorcycle riding, a recent violation of which caused disastrous consequences.[5] Contracts with theatrical stars often prohibit dangerous activities such as hang gliding and skydiving because of the difficulty of hiring an acceptable substitute when injuries occur.[6] In each case, the employer chooses hiring policies tailored to its own needs and circumstances, and cascades of discriminatory practices rarely (if ever) flow down that less-than-slippery slope.

Sugarman discussed many types of off-duty worker behavior that may clash with employers’ interests, including personal (social/sexual) relationships, civic and political activities, leisure activities, moonlighting, characteristics of daily living (eg, health behaviors, personal appearance), and illegal acts.[6] The rationale for addressing these behaviors in corporate hiring policies may be strong in some cases and weak in others. But as Seligman noted, "Employers are not always right, but they are guaranteed to do better than regulators and judges in deciding which employees will be the most productive."[7]

Currently 30 states in the US have "smokers’ rights" laws on the books.[4] Nevertheless, an estimated 6,000 employers no longer hire smokers, according to the National Workrights Institute.[8] That number may seem large, but it’s only a small fraction of the 20.8 million businesses in the country.[9] Smokers can still find jobs, and employers can decide for themselves whether to employ them. Tobacco control advocates should oppose laws that give smokers special protection similar to the protections afforded to groups defined by race, ethnicity, gender, age, and disability.

Ronald M. Davis, MD

Director

Center for Health Promotion and Disease Prevention

Henry Ford Health System

Detroit, Michigan, USA

1. Malouff J, Slade J, Nielsen C, Schutte N, Lawson E. US laws that protect tobacco users from employment discrimination. Tobacco Control 1993; 2: 132-138. http://tc.bmjjournals.com/cgi/reprint/2/2/132.pdf

2. US Equal Employment Opportunity Commission. Facts about pregnancy discrimination. http://www.eeoc.gov/facts/fs-preg.html (accessed 25 March 2005)

3. Thompson B. Bruce Thompson’s fallacy page: slippery slope. http://www.cuyamaca.net/bruce.thompson/Fallacies/slippery.asp (accessed 25 March 2005)

4. Peters JW. Company’s smoking ban means off-hours, too. New York Times, 8 February 2005: C5.

5. Dodd M. Bulls' Williams likely to miss season after accident. USA Today, 24 June 2003. http://www.usatoday.com/sports/basketball/nba/bulls/2003-06-23-williams- injuries_x.htm (accessed 25 March 2005)

6. Sugarman SD. "Lifestyle" discrimination in employment. Earl Warren Legal Institute, 27 June 2002. Paper 1. http://repositories.cdlib.org/ewli/1 (accessed 25 March 2005)

7. Seligman D. The right to fire. Forbes, November 2003. http://www.forbes.com/forbes/2003/1110/126.html (accessed 25 March 2005)

8. Ozols JB. A job or a cigarette? Newsweek, 24 February 2005. http://msnbc.msn.com/id/7019590/site/newsweek (accessed 25 March 2005)

9. US Census Bureau. 1997 Economic census: minority- and women-owned businesses, United States. http://www.census.gov/epcd/mwb97/us/us.html (accessed 25 March 2005)