A few years ago, politicians introduced us to a new metric for performance; estimates about what might have happened became real numbers that were shown as proof of success. Instead of touting actual economic benefits from tax spending, we were treated to the economic losses the spending avoided. No one knew if the numbers were real because they hadn't happened, they were only estimated by the same political groups interested in promoting their success.

It was dizzying, and it worked in the mainstream media, and so it was only a matter of time before other agenda-based groups adopted the same technique.

And so a group of anti-cigarette advocates did a review and made an estimate and write in the New England Journal of Medicine that tripling taxes on cigarettes around the world would reduce the number of smokers by one-third and there prevent 200 million premature deaths.  Tobacco is implicated in almost 200,000 deaths a year of people under 70 in Canada and the United States (120,000 men and 80,000 women) but the actual numbers are unclear. A lot of diseases that are aggravated by smoking are included in those figures and if you get lung cancer and don't smoke, they still attribute it to second- and even third-hand smoking. Regardless, they believe that doubling cigarette prices would prevent about 70,000 of those deaths and, sure to appeal to everyone, provide more money for governments to spend on health care. 

Yes, they advocate making social services more reliable on a revenue stream they are trying to eliminate. Since these are lives saved or gained, there is no harm in using pretend dollars as well, so their estimated $400 billion just in the US is sure to get the attention of policymakers, until they realize it is not actual money. 

If that many lives would be saved, why not just ban cigarettes? Lots of people want to ban semi-automatic rifles and those only kill 500 people per year.  That is even more people than will be killed by the environmental crusade against vitamin-enriched rice, after all. The authors contend that doubling the price of the cheapest cigarettes would encourage people to stop smoking without a pesky ban - except for the wealthy. It would certainly penalize poor people in poor countries, though, and that would help them in the end, since they can't control themselves. It even helped in France, where they halved cigarette consumption between 1990 and 2005 by raising taxes well above inflation. Smoking became a pastime for the wealthier.

"Death and taxes are inevitable, but they don't need to be in that order," said co-author  Dr. Prabhat Jha, a professor in the Dalla Lana School of Public Health at the University of Toronto. "A higher tax on tobacco is the single most effective intervention to lower smoking rates and to deter future smokers."

"Worldwide, around a half-billion children and adults under the age of 35 are already – or soon will be – smokers and on current patterns few will quit," said co-author Professor Sir Richard Peto of the University of Oxford. "So there's an urgent need for governments to find ways to stop people starting and to help smokers give up. This study demonstrates that tobacco taxes are a hugely powerful lever and potentially a triple win – reducing the numbers of people who smoke and who die from their addiction, reducing premature deaths from smoking and yet, at the same time, increasing government income. All governments can take action by regularly raising tobacco taxes above inflation, and using occasional steep tax hikes starting with their next budget. Young adult smokers will lose about a decade of life if they continue to smoke – they've so much to gain by stopping."

Jha and Peto noted that the 21st-century hazards of smoking have been reliably documented only in the past year, when several researchers published papers showing that men and women who started smoking when they were young and continued throughout adulthood had two or three times the mortality rate of non-smokers. An average of 10 years of life is lost from smoking. Many of those killed are still in middle age, meaning on average they lose about 20 years of life expectancy.

Both Dr. Jha and Sir Richard wrote papers last year contending that people who quit smoking when they are young can regain almost all of the decade of life they might otherwise have lost. When is that magic threshold when people can still safely quit? It depends. 

Citation: Prabhat Jha, M.D., D.Phil., and Richard Peto, F.R.S., 'Global Effects of Smoking, of Quitting, and of Taxing Tobacco', N Engl J Med 2014; 370:60-68 January 2, 2014 DOI:10.1056/NEJMra1308383