Louisville Medicine Volume 67, Issue 10 | Page 32

DOCTORS' LOUNGE SPEAK YOUR MIND If you would like to respond to an article in this issue, please submit an article or letter to the editor. Contributions may be sent to [email protected]. The GLMS Editorial Board reserves the right to choose what will be published. Please note that the views expressed in Doctors’ Lounge or any other article in this publication are not those of the Greater Louisville Medical Society or Louisville Medicine. TAXING TOBACCO TALES AUTHOR Mary Barry, MD T axing tobacco is hitting the three. It’s the walk-off triple that empties the dugout. It’s bowling 300 on a Thursday night. It’s the goal-line tackle that saves your season and ruins theirs. It is, in fact, the only tax that feels good to levy. For far too many years, Kentuckians who smoked enjoyed the cheapest cigarettes around; the Civil War brought us the first federal tobacco tax that stuck, in 1862, because of the Union’s growing debts. After much ado and years of advocacy, in 2018 we finally got our tax raised from 60 cents a pack to $1.10. Each pack is also taxed at the $1.01 federal rate and big cities have added their own taxes. In NYC, you’ll pay $12.85 for a pack of Marlboros, and $5.40 here. Missouri is still the cheapest place to ruin your lungs, at only 17 cents state tax per pack. But per the “State of Lung Cancer” report from the American Lung Association, Kentucky still leads the nation in lung cancer incidence, 92.6/100,000 people; Missouri ranks 45 th with an incidence of 73.2/100,000 people. We know too well that so many cancers are related to smoking; so many illnesses and hospitalizations and complications are related to COPD from smoking, so many brittle bones, pneumonias, falls, laryngectomies and deaths are from smoking. We look at the beauty and vigor of our teens, and our hearts just break at the thought that they, too, will become the frail old lady in the wheelchair and not the master swimming champ. We look at the millions and millions this country spends on health care for smokers and our blood boils at the sheer needlessness of it all. Not one of those dollars was a necessary nor inevitable expenditure. Not one was paid willingly by anybody; all of those costs were borne out of mercy, since none of us is perfect. We begrudged every dollar. Since June, 2,602 people have fallen ill to the vaping-use associated lung injury, EVALI, with 64 dead as of Feb. 11—the youngest a 15-year-old boy in Texas. In 2018, about 3.6 million of our teenagers used electronic cigarettes and last year, 5.4 million—a huge jump. We have no way yet – when this generation is 80, we should know – just how much lung, head, neck and other 30 LOUISVILLE MEDICINE cancers will grow only from the use of e-cigarettes, not Marlboros. For this is the first generation truly to eschew old tech for new tech, the vaping devices. Right now in our General Assembly, the bipartisan House Bill 32 proposes to add an excise tax on e-cigarette/tobacco vaping of 27.5% - the same tax rate as the current cigarette tax. Led by Rep. Jerry Miller, nine representatives are working hard for support on this bill. Many doctors and citizens have joined in support and it was reported favorably after a first reading. We need a second reading to get a vote; here’s a good stat to use when you call your senators and representatives. Tell them that regular cigarette sales dropped by 36 million packs in this state after the 2018 tax hike. The greatest drop in purchasing was among the young, the pregnant and people living in poverty. Dr. Gordon Tobin has written a strong recommendation to base the taxation on the nicotine content delivery of the vaping device: that’s the addicting, danger-laden part. I favor a tax like New York City, but that’s unlikely here. A tax that starts at 27.5% and rises in proportion to the amount of nicotine per e-cigarette would be the best financial approach to help Kentuckians to quit. As poor as we are as a state – as debt-ridden, pension-strapped, underpaid and overworked as we are – taxing the evil weed is a brilliantly lucrative move. It pays off in health. It pays off in prevention. It pays off in fixing potholes, paying teachers, funding scholarships and cancer research. It should help pay for lung cancer screening. Retirement pools might overflow. We can send lots of cash to our Community Health centers, the backbone of mental health care in this state. The e-cigarette tax should help pay for outreach to schools, church groups, camps and sports teams for the 12-20 age groups. We have to show them the facts. Taxing e-cigarettes should save lives: and that’s the winning goal. Dr. Barry is working at various Norton CMA offices as a “float/fill-in” only position. She is a clinical associate professor at the University of Louisville School of Medicine, Department of Medicine.