Health Update: Smoking Makes a Comeback in the Age of Wellness – What Experts Say

In the 1950s, half of American adults smoked. Upperclassmen paid by tobacco companies handed out free cigarettes to incoming freshmen as a kind of welcome ritual. Even before the U.S. Surgeon General declared in 1964 that smoking causes lung cancer, most people already sensed that tobacco was bad for their health. A character in O. Henry’s short story published in 1906 asks, “Say, buddy, got a coffin nail?” — “coffin nail” serving as a metaphor for tobacco. Sarah Milov’s 2019 book “The Cigarette: A Political History” vividly depicts medical professionals enjoying their smokes. The book describes how “members of the medical board gathered in a room at the National Library of Medicine, the air thick with smoke, the tables covered with papers and ashtrays.”

Until the mid-20th century, smoking carried an image of sophistication and allure. But once it came to be seen as foolish and outdated, some followed the change. The broadly educated and well-informed middle class heeded public health warnings, while the working class did not.

In a world where everything has an expiration date, smoking is making a comeback. During the COVID-19 pandemic, people isolated in fear reached for cigarettes again to fill idle hands. Now some celebrities are lighting up. Smoking scenes in movies are on the rise. One might wonder whether health authorities should issue warnings that Hollywood films may cause cancer.

Katie Roiphe, an author and professor, told the Wall Street Journal: “In this era of health obsession, of kale salads and Pilates, you see people recklessly indulging in pleasure.” She noted that young people ask, “With school shootings, food prices soaring from climate change — when everything in the world is terrible — why not smoke?” They may view smoking as a tolerable form of self-abuse, she said.

Healthcare accounts for 18% of the U.S. economy and is growing. One reason is smoking. In 1919, a doctor at a St. Louis hospital summoned medical students to the autopsy room. He said the deceased’s disease was so rare they might never see it again in their lifetimes. The disease was lung cancer. One of those students said he did not see another case until 1936. Then he saw nine within six months. Consider what has become of lung cancer, once so rare.

Technological advances, wars, and women’s liberation changed many things. Making cigarettes was a small-scale cottage industry until the cigarette-making machine was invented in 1881. The machine made cigarettes cheaper. During two World Wars and the Korean War, cigarettes were free or cost just five cents a pack — practically a perk of military service. In Ernest Hemingway’s 1926 novel “The Sun Also Rises,” not only men but women smoke incessantly. Today, smokers are generally treated as social pariahs, shivering outside their workplaces in winter to smoke. There was a time when George Washington, the first U.S. president, was a Virginia tobacco planter, but now America has more former smokers than current ones. Yet tobacco manufacturers still thrive because of what the Economist has called “the paradoxical economics of smoking.”

Tobacco is one of the most heavily taxed consumer goods in the world. U.S. state governments are addicted to cigarette tax revenue. New York’s cigarette tax alone reaches $5.35 per pack.

Calculating the “net cost” of smoking — the No. 1 preventable cause of death in the United States — is complicated. Costs consist of medical expenses, productivity losses from illness and shortened lifespans, and fire damage. Yet smoking-related deaths also reduce spending on Social Security, pensions, and nursing home care that would otherwise be paid to smokers. Smoking has produced interesting product liability lawsuits, because it is now almost universally known that cigarettes are harmful even when used as intended.

Only a quarter of cancer deaths are said to be smoking-related. But would you board a plane if there were a 25% chance it would crash? Someone once said, “Kissing a smoker is like licking an ashtray.” Perhaps such blunt remarks have done more to curb smoking than the Surgeon General ever did.