Should the FDA regulate tobacco?

According to the New York Times today, "Report Seeks FDA regulation of Tobacco",

A report from the Institute of Medicine, part of the National Academy of Sciences, urged Congress and the president to give the Food and Drug administration the authority to regulate tobacco.

Use of tobacco is recognized in Public Health as the second largest cause of premature death in the world today. The World Health Organization estimates that half of the smokers will be eventually killed by that habit, with the death toll 5 million people per year now, and rising.

So, this is a surprising thing. The USA launches a whole occupation army and spent over a trillion dollars because 3000 people were killed. But the same country sits by and watches the tobacco industry kill 5 million people a year, every year, and that's no big deal.

We really need to pause and make sense of these observed facts, and what they can teach us about ourselves.

There is a very long history of attempts to regulate tobacco, which has a specific exemption put in place by our very own Congress, specifically to prevent such regulation. Any consideration of that kind of regulation also has to look at the dismal results when the US tried to regulate the sale of alcohol during "prohibition" with a constitutional amendment.

The Times story continues:

The report said cigarettes contained carcinogens and other dangerous toxins and would be banned if federal laws did not exempt tobacco. A bill before Congress would give the F.D.A. regulatory authority, but the agency’s commissioner, Dr. Andrew C. von Eschenbach, expressed skepticism, saying that if nicotine levels were reduced, smokers would change their habits to maintain current levels. The report also called for higher tobacco taxes and a national ban on indoor smoking.

The Johns Hopkins Institute for Tobacco Control estimates that 1 billion people will die prematurely, in the 21st century, from use of tobacco. According to that site, "The Institute for Global Tobacco Control works to prevent death and disease from tobacco use through research, education and policy development."

Apparently, "research, education, and policy development" have not been very successful and solving this problem.

In fact, while non-smoking areas are now commonplace in places wealthy Americans hang out, the companies have only moved operations abroad and expanded them tremendously. The death toll is expected by WHO to double in by 2020, to 10,000,000 people - a year, each year.

I would like to suggest that "research, education, and policy development", while helpful locally, will never solve this problem.

There are two reasons I think that, related to the whole theme of this weblog.

First, our ability to reason about such things is poor. The fixation on numbers in much of Science, and explicit belief by many that only numeric results are meaningful, has short-circuited our ability, as a society, to reason correctly about things that cannot be measured with numbers. Even for things that can be measured with numbers, the fixation on linear statistical models has short-circuited our exploration of feedback models.

In the perverse way of complex systems, our biggest problem is now of our own making. Like the blades of a helicopter, we must travel in our own wake. The very success of the mechanical view of the universe, of Science and technology, and of linear statistical models have made it almost impossible to now move forward from there. These techniques have, effectively, become religions, defended with blind religious zeal against perceived enemies at the gates.

So, when we are confronted with a problem which shimmers and changes with the size and scale of the observer, we are effectively paralyzed. Do tobacco companies kill people? On the scale of populations, the cause and effect is clear and unambiguous, and satisfies all the requirements of causality, except one we'll get to. Raised marketing efforts by tobacco companies precede and have a dose-response relation to the number of people smoking and the number of people dying. Etc. The problem is that if we shift lenses, on the scale of individual humans, this relationship is no longer "causal." Individuals have free will. Any particular individual may or may not respond to marketing efforts by the tobacco industry. The solidity dissolves.

It's not that there is no solidity to the causal argument - it's that the solidity depends on scale, which is a concept that is not yet recognized as pervasive and important.

I go on about this at great length in some other posts. ( Search "scale" or "causal" in the search window above to find them. ) See "Ten most important lessons from physics" for a discussion of how even water pipes have this property. From a human scale, there are entities called pipes, and water towers, and faucets and there are measurable factors like pressure and volume and flow-rates. These seem very solid. But if you drill down to the molecular level, this solidity dissolves. Molecules don't think, or act, or respond to any of that. Those words are meaningless to molecules. Molecules just respond to their local environment, and their neighboring molecules. A given molecule may linger at the pipe wall forever, it doesn't matter.

A few more such examples are given in my post: Amazing devices to impress your friends.
These include hollow tubes that cause air to separate into boiling hot air and air so cold it creates frost, pumps that pump water uphill with no power source and essentially no moving parts, hollow spaces that convert battery power to microwaves in one step with no moving parts, etc. These are all commercial, off-the-shelf devices, not my imagination gone wild.
They also all have the property of being globally causal and locally non-causal. Like the photo of Marilyn Monroe or Einstein, depending on how far back you stand from your monitor, they are both at once and fall into a space we are not taught about in school.

The second reason that "research, education, and policy development" have not been very successful and solving this problem of tobacco-related deaths is that this is a spiritual problem, and it will never yield to technology.

As T. S. Eliot noted, in Choruses from The Rock (1934):

They constantly try to escape
From the darkness outside and within
By dreaming of systems so perfect that no one will need to be good.
But the man that is shall shadow
The man that pretends to be.

Or, more precisely, the society that is shall shadow the society that pretends to be. Any individual effort to change the situation with respect to tobacco use will fail on two fronts.
First, the industry will fight back, and that is a cross-scale fight that pits corporations against individuals and guess who will win. Second, human weakness will fight back against our best intentions for our own behavior, and we will give in, as we did with alcohol. The latter is what the FDA Commissioner was referring to, in that regulations limiting tobacco per cigarette would only increase the number of cigarettes smoked until the same physiological hit was obtained, making the industry even richer.

In the contest between an individual and a multi-billion dollar corporate marketing campaign, it is not likely the individual will win.

There are exceptions. For instance, the population of Latter Day Saints (Mormons) in Utah has a well-documented life expectancy ten years longer than the average for the US, and one reason is that they prohibit smoking and drinking.

Look what is going on here. It is not the individuals that are fighting off the temptation to smoke or drink, but the larger scale entity, the, gasp, organized religion, that has succeeded where
"research, education, and policy development" have all failed.

One of the youth in our community asked one day "Why do we need organized religion? Why can't we all just worship God on our own?" The answer is visible in Utah -- larger scale entities can do things that smaller scale entities cannot possibly ever, ever, ever do on their own.

This is not a "cognitive" thing. Yielding to temptation and losing ability to deliver on one's own intentions is a function of being disconnected from a larger entity that helps shape and define and support you, and provides you what structural engineers call "active strength." The simple fact is that human beings are heavily influenced by peer pressure, whether they like it or not, or believe it or not, or have IQ's of 200 or 20.

It's not so much a question of which entity to belong to. Pick one that looks good. What matters is belonging to something larger that supports the values you desire your "self" to have.

Life is too complex to go it alone. We've seen to that. The one church that does not work, and will never work, is "rugged individualism." Whether you believe in God or not, or evolution or not, the math is the same - no individual will ever be as strong as a strong group. In the end, strong groups will win. Multi-celluarism always wins out, in the end - it's just a better solution. The fact that you're reading this shows that multi-cellular architecture can work, because that's exactly the operating principle your body uses to orchestrate a trillion cells and get one body. We're swimming in examples of this working.

Wrapping up the social thought - tobacco deaths continue because we accept them. If we, as a society, collectively, decided we didn't want our companies killing 5 million people a year, we could stop that cold. Such an action requires moral conviction and group solidarity of a type that will not come from "research, education, and policy development".

Such an action requires a change of heart.

Change everyone's heart, and the "problem" will dissolve. Suddenly, "we" will be at the same scale as "the problem", and the "problem" will simply evaporate.

So, I'd suggest that focus as the most likely to succeed. It demands that we come to grips with larger questions of society, morality, religion, science, and our own nature. It's not a simple thing to do, but, from the reasoning above, it looks to me like the easiest thing to do that has a chance of working, based on fundamental principles of what's going on here and the evidence at hand of what works and what doesn't.

Religion, like gasoline, is volatile. It releases tremendous energy in people, for good or bad. It can be misused, and it can kill. It can also power our lives with non-polluting ability to cope.

We don't need to throw out religion. We need to understand, when it works, why it works. There is no shorter path to the solution to the problems we've now made for ourselves, and no path that doesn't involve these questions.