The Civil Liberty of Smoking Cigarettes

[AQ1] [AQ2] Editorials Th e Civil Liberty of Smoking Cigarettes [AQ3] Laura E. Crotty Alexander , MD [AQ4] Atul Malhotra , MD, FCCP La Jolla, CA Some political fi gures have made a point recently about the importance of civil liberties. Th ese individuals point to the importance of freedom and discourage government interference in personal matters. Despite the known health risks, 20% of the US population smokes conventional tobacco cigarettes. 1 Many smokers argue that they enjoy the habit and do not believe that others should have the right to regulate their behavior. Smokers represent a fi nancial burden on the health-care system, but pay considerable consumption tax during their lifetime and, thus, their economic impact could be debated. The argument changed from one of personal freedom to include issues of public health when the impact of secondhand smoke (SHS) was recognized. No longer were smokers simply aff ecting themselves, but also their children, spouses, and other innocent bystanders. Indeed, roughly 40% of children worldwide are regularly exposed to SHS, and 600,000 people are predicted to die annually from SHS. 2 , 3 Some data also suggest that smoke exposure may have transgenerational consequences such that an individual’s adult health may be aff ected by prior exposures experienced by one’s mother or grandmother. 4 In addition to cigarette smoking, other behaviors have been debated. Vaccinations in children are being provided inconsistently, in part due to infl uential voices who advocate against them. Some of these individuals Division of Pulmonary, Critical Care and Sleep Medicine (Drs Crotty Alexander and Malhotra), University of California San Diego; Pulmonary and Critical Care Section (Dr Crotty Alexander), VA San Diego Healthcare System. FINANCIAL/NONFINANCIAL DISCLOSURES : Th e authors have reported to CHEST that no potential confl icts of interest exist with any companies/organizations whose products or services may be discussed in this article. CORRESPONDENCE TO: Atul Malhotra, MD, FCCP, University of California San Diego, 9300 Campus Pointe, La Jolla, CA 92037; e-mail: amalhotra@ucsd.edu © 2015 AMERICAN COLLEGE OF CHEST PHYSICIANS. Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details. DOI: 10.1378/chest.15-0340 AFFILIATIONS: [AQ5] [AQ6] [AQ7] journal.publications.chestnet.org point to potential risk of vaccines despite no compelling data 5 and ignore the transformative benefi ts that vaccines confer. Clearly, the issue of withholding vaccinations from children is not just one of civil liberties but of potentially endangering the population at large. Similarly, seat-belt legislation was resisted by many based on civil liberties, but some measures have produced widespread benefi ts for society. Sleep deprivation was also considered a matter of individual choice, but once data showed a risk of motor vehicle accidents and other occupational risks, the matter no longer became limited to the individual, because the wellbeing of the community needed to be considered. 6 Finally, required hand washing for those in the food services industry, for the simple and very clear reason of preventing transmission of diseases such as hepatitis A and pathogenic Escherichia coli to the community, is being challenged as impinging on civil liberties. In this issue of CHEST , Adams et al 7 (see page 䊏䊏䊏 ) provide a sophisticated analysis of the mechanisms underlying cardiovascular risk of SHS. Using an elegant technique developed by the Jelic laboratory, 8 the authors isolated endothelial cells from venous scrapings and studied the infl ammatory and vasodilatory properties of these cells. Th e authors argue that mechanisms underlying cardiovascular risk in people exposed to SHS are poorly understood and hypothesize that the vascular biology of endothelial cells from people exposed to SHS is aff ected by the exposure. Indeed, the authors observed that expression of endothelial nitric oxide synthase (eNOS) and phospho-eNOS was decreased similarly in cigarette smokers as compared with individuals exposed to SHS. Also, levels of nuclear factor- k B, an important infl am- matory transcription factor, were increased similarly in cigarette smokers and individuals exposed to SHS. Th e findings were compared with endothelial cells from nonsmokers who did not display these same abnor- malities. To test the clinical relevance of the observed abnormalities, the authors also performed fl ow-mediated dilation of the brachial artery in response to ischemic stimuli, and observed a similar degree of impairment in smokers as compared with individuals exposed to SHS. 9 Clearly, both smokers and innocent bystanders may be affected by this toxic inhalation. The data provide compelling rationale for limiting exposure of irritants to all involved.