In Defense of the Indefensible
David E. Williams of the Health business blog wrote an entry in his blog yesterday titled, “In defense of smoking“, wherein he criticizes Steven A. Schroeder, head of the Smoking Cessation Leadership Center at UCSF for failing to mention (in a Washington Post article advocating banning smoking from mental health facilities) that “smoking helps [schizophrenics] feel less crazy”. He goes on to say that it’s “probably worth encouraging some mental health patients to quit but it’s not probably not so clear cut.” (I’m not making this up.)
He cites an article by Dr. Henry Nasrullah on healthtalk.com (Smoking and Schizophrenia: Does Nicotine Help Schizophrenia?) in support of his statement that “smoking helps [schizophrenics] feel less crazy” (which is not the sense that I get from Dr. Nasrullah’s article), but then Mr. Williams fails to mention that Dr. Nasrullah goes on to say that, “The newer anti-psychotic medications can help repair the nicotine deficit in the brains of persons with schizophrenia without the need for smoking. Thus, it is not unusual to see some persons with schizophrenia quit smoking after being treated on psychiatric wards, the majority of which are smoke-free.” (emphasis added.)
Could Mr. Williams’s own omissions be due to the fact that his company, MedPharma Partners LLC “provides management consulting and business development services to pharmaceutical, biotechnology, medical device, and technology enabled healthcare service organizations of all sizes”? After all, fewer cancer, heart, and COPD patients would mean less business for “pharmaceutical, biotechnology, medical device, and technology enabled healthcare service organizations of all sizes”, and less business for those entities would presumably mean less clients for Mr. Williams’s company, wouldn’t it?
Besides, they’re only “crazy” people anyway…
Right, Mr. Williams?
In my post I make two points:
1. High cigarette taxes are unfair to the mentally ill. If they smoke almost half the cigarettes then they probably pay almost half the cigarette taxes, too. Social programs are often funded by increasing cigarette taxes, with the idea that this is just taking money from smokers who deserve to be punished anyway. If it were widely understood that such a policy placed a disproportionate burden on the mentally ill, support might be less widespread.
2. Schroeder advocates a blanket ban on smoking in mental health facilities without acknowledging that –at least for some patients such as schizophrenics—smoking provides therapeutic benefits as well as causing harm. In general the bad outweigh the good but Schroeder does readers a disservice by failing to mention that mentally ill smokers aren’t the same as those without mental illness.
It was amusing to read that my opinions are influenced by my consulting business interests. My post looks more like something the Tobacco Institute would want someone to say, don’t you think?
Regular readers of the Health Business Blog know that I write what I think, regardless of whose ox is gored. Often it’s pharma companies and health insurers.
For a more comprehensive view on the relationship of smoking and schizophrenia, see this special report from schizophrenia.com. http://www.schizophrenia.com/smokereport.htm
Finally, I take exception to your comment about “crazy” people. That may be your opinion. It definitely isn’t mine.
Thanks for the response, Mr. Williams.
First of all, I didn’t address your point about taxes in my post, and I won’t now.
Secondly, I still don’t find anything in the article you cited by Dr. Nasrullah to support your contention that “smoking helps [schizophrenics] feel less crazy”. But I do find a major point that Doctor Nasrullah makes about the newer anti-psychotics obviating the need for smoking in schizophrenic patients, which you failed to mention in your article (presumably because it would lessen the impact of your statement that “smoking helps [schizophrenics] feel less crazy”).
Thirdly, since you clearly expressed the opinion that schizophrenics are crazy, and then the opinion that “it’s not so clear cut” that they should be encouraged to quit smoking (presumably because, in your words, “smoking helps them feel less crazy”), I think it’s perfectly reasonable for your readers to conclude that you believe it’s OK for “crazy” people to continue to smoke. And, since there can hardly be any debate about the deadly consequences of feeding this addiction, one could reasonably conclude that you hold “crazy” people’s lives to be worth less than “normal” people’s lives.
As to your reasons for holding these opinions, I can only guess; they certainly don’t seem to come from a careful reading of the sources you cite. To quote from the article you cite here:
“As we suggested above, however, the studies are far from conclusive. A 2005 study in the British Journal of Psychiatry (mentioned above) noted ‘Smoking may have a beneficial effect on either schizophrenic symptoms or antipsychotic side-effects, but studies are hampered by the lack of control of confounding factors.’”
Finally, it was not me that said that “smoking helps [schizophrenics] feel less crazy”; it was you. It was not me that suggested that encouraging these “crazy” people to quit smoking was not necessarily such a good idea (for whatever reason). Since these were your words, which appeared in your blog, I assumed they expressed your opinion. Perhaps I was mistaken.
Thanks Kevin. Rather than parse your comments extensively I’d suggest people read the original sources and draw their own conclusions.
Overall I’m trying to raise the point that smoking for schizophrenics is not quite the same as smoking for the rest of us. That factor should be acknowledged in any policy discussion or we risk doing more harm than good by copying policies that have worked elsewhere.
Schizophrenics are crazy. That doesn’t mean they’re any less important as human beings.