The report by Lightwood and Glantz1 on the short-term economic and health benefits to be gained by an aggressive antismoking campaign directed at adult smokers provides a thoughtful analysis designed to encourage policy makers to take appropriate action. Since the perspective comes from Dr Glantz, who has devoted an entire career to combating the pernicious tobacco habit, one is inclined to heed his advice.
Cigarette smoking has been cited as the leading preventable cause of death in the United States and a major contributor to the huge annual economic costs imposed by the cardiovascular and lung diseases it promotes.2 3 It was estimated in the Framingham Study that cigarette smoking accounted for 55% of the coronary events observed in a cohort aged <55 years.4 The preventive potential of smoking abatement in adult smokers to avoid coronary disease is huge because those who quit have only half the risk of those who continue to smoke, regardless of how long and how much they previously smoked. Getting smokers to quit deserves a high priority among measures advocated to prevent cardiovascular and lung diseases.
Lightwood and Glantz correctly point out that despite the huge death toll and medical costs attributed to smoking, resources are only grudgingly allocated for programs to combat smoking. They point out that aside from the shameful bowing of our politicians to the interests of the tobacco industry, the tobacco control advocates have to contend with the need of policy makers to justify spending money now to save money in the future. They therefore undertake to show how policy makers can justify a current short-term expenditure.
It clearly takes a very long time to reduce treatment costs for cancer and emphysema.5 However, the benefits of smoking cessation occur rapidly for coronary heart disease and stroke, reducing risk by half within 2 years. These illnesses are costly, and delaying or preventing them provides substantial short-term financial returns for health insurers.
The estimate by Lightwood and Glantz of the short-run impact of a trivial (1%) reduction in the prevalence of smoking on the medical cost savings that would be derived from the prevention of smoking-induced myocardial infarctions and strokes is most impressive. They estimate that an annual 1% reduction could result in 98 000 fewer hospitalizations and save $2.7 billion. What is impressive about these estimates is that they are so conservative: they take into account neither the fact that continued smoking also increases the risk of recurrent myocardial infarctions and strokes6 nor the costs of rehabilitation, long-term treatment, or lost wages and productivity. They make a good, conservative case for investment in adult smoking abatement by health insurers and government health officials.
However, regardless of the merits of this approach, we must not lose sight of the fact that primary prevention of smoking in children and teenagers is the key to making substantial inroads against this pernicious habit. Smoking generally starts in the teens and becomes a long-term tenacious problem because of the addictive properties of nicotine. Cigarettes are a dangerous product that is allowed on the market even though it is lethal and disabling when used exactly as directed. The issue of free choice is a travesty because of the addictive properties of cigarettes. The high percentage of smokers who want to quit and cannot do so testifies to the need to keep teenagers from taking up the habit. It is time for the Food & Drug Administration to take steps to regulate the sale and use of tobacco products.
Dr Kannel is supported by the NIH, NHLBI grant No. N01-HC-38038; ASTRA USA, Inc; and the Framingham Visiting Scientist Program.
The opinions expressed in this editorial are not necessarily those of the editors or of the American Heart Association.
- Copyright © 1997 by American Heart Association
Lightwood JM, Glantz SA. Short-term economic and health benefits of smoking cessation: myocardial infarction and stroke. Circulation. 1997;96:1089-1096.
Reducing the Health Consequences of Smoking: Twenty-five Years of Progress. Atlanta, Ga: Centers for Disease Control, Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 1989. US Dept of Health and Human Services.
The Health Benefits of Smoking Cessation: A Report of the Surgeon General, 1990. Atlanta, Ga: Centers for Disease Control, Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 1990. US Dept of Health and Human Services, Public Health Service.