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August 1986

A Burning Issue: Health and Wealth up in Smoke

Author Affiliations

Vanderbilt University Medical Center Nashville, TN 37205

Arch Intern Med. 1986;146(8):1494-1495. doi:10.1001/archinte.1986.00360200044005

Smokers must face the fact that they do not live in a vacuum. Never mind the 'passive' smoking controversy for the time being; smoking adversely affects things more near and dear to nonsmokers' hearts than their lungs—it reaches into their very wallets as well. A recent article in the New England Journal of Medicine estimates that the increased annual cost of medical care directly attributable to smoking and paid through higher taxes and health insurance premiums for everyone—including nonsmokers—is in excess of $100 per person.1 Thus smoking is more than mere self-indulgence and self-destruction; in this context, smoking is a crime.

In terms of 1985 dollars, smoking accounts for over $16 billion in total direct health care and an additional $37 billion in lost productivity and earnings every year.1 Certainly, smokers pay some of these costs through taxes on each pack of cigarettes they purchase, but they