By Steve Heilig, MPH

Originally posted on sfgate.com, June 4, 2012.

Did you pay any taxes last year? If so, and even if you don’t smoke tobacco, some of your money went to pay for the costs of tobacco-related disease—and helped put money into tobacco industry coffers as well.

If you don’t like that deal, Proposition 29 won’t fix it, but it will help.

Just in case there is one reader out there who is still undecided regarding Proposition 29, here are a few concise items to consider.

• I’ve followed the debate closely, and posted about it once before. There has been a heated debate in medical/public health forums about some of the specifics of the proposition. I’ve read many of the online comments on many stories to see if I’ve missed some compelling argument against raising the tobacco tax in our state. And I’m left with this impression: Proposition 29′s passage would represent a victory of good over evil.

• We all must know the basics by now—tobacco kills, is marketed aggressively to kids and the poor, and many of the resulting health costs are borne by taxpayers. Prop 29 would level the playing field a bit by getting California into the mid-zone of tobacco tax rates. It would deter some smokers from starting or get them to quit. The research would help us find better prevention and treatment. The real choice is thus: Do we all want to keep paying the costs of smoking while subsidizing the tobacco industry’s profits, or reduce the number of smokers and find better ways to prevent and treat tobacco-related disease?

• It’s not even a new tax—it’s an increase in an old one. It’s not an unfair one—the current “arrangement” is unfair, especially to the poorer and younger people who are more likely to be smokers. The revenue would not go out of state, the net economic result would be positive… and so on, all contrary to the tobacco-industry propaganda being widely parroted with help from tobacco funds. Most important is the fact that a tax increase will lead to there being less smokers.

• Big Tobacco knows all this as well as anyone—they would not spend so many millions of dollars, buying votes and advocates to fight 29, if they did not know it would deter smoking. The list of otherwise respectable organizations who have been bribed by tobacco funds is sad and sordid, as detailed here and here.

• Big Tobacco’s strategy is detailed in an internal memo from the last time a tobacco tax increase was proposed: ‘The tobacco industry is currently losing the public relations war with the general public…  the only way to defeat any of the hostile tax increase measures currently in circulation for the November ballot in California, is to build a coalition of groups more favorable to the public without the fingerprints of tobacco on it.‘”

• In other words, they know they have to use deceit and lies. My favorite op-ed on Proposition 29 came from the Solano-Napa Times-Herald, titled “Big Tobacco has No Shame”. They note: “The shameful, deceitful, irresponsible ad campaign by Big Tobacco on California’s Proposition 29 seems so transparent that one would think it was a theatrical satire rather than a duel to the death. But a duel to the death it is.”

I may be jaded and perhaps biased (although I should add, I would receive nothing from the revenues Prop 29 would gather), but I still think marketing disease and death is evil. Besides that, I don’t like paying for it, but I do think helping tobacco addicts is a good thing, and preventing addiction even better. And so, I voted yes on Proposition 29.

The Yes on Proposition 29 campaign continues to receive a “digital boost” with the release of a new tongue-in-cheek ad campaign.

The video exposes the deceitful campaign being waged by Big Tobacco against the June 5 initiative that will raise the price of a pack of cigarettes by one dollar. This extra dollar will only be paid by those who purchase tobacco products. If you don’t smoke, you don’t pay. The extra dollar will fund life-saving research, keep kids from smoking and help smokers quit.

The edgy and compelling video challenges voters to look critically at Big Tobacco and its quest to defeat an initiative that is supported by SFMS, California Medical Association, American Cancer Society, American Lung Association, and the American Heart Association.

Prop 29, an initiative on the June 5 primary ballot, will raise the cost of a pack of cigarettes by one dollar and dedicate those new funds to cancer and other tobacco-related disease research and smoking cessation efforts. Written by the American Cancer Society in California, the American Heart Association, Western States Affiliate and the American Lung Association in California, Prop 29 is supported by the Lance Armstrong Foundation and doctors, scientists and researchers throughout California. Research shows that raising the cost of cigarettes by one dollar a pack will save 104,000 lives and stop 228,000 kids from smoking.

By Peter Curran, MD and Steve Heilig, MPH

What is the leading cause of preventable morbidity and mortality in the nation? Tobacco. What is one proven way to reduce that harm and mitigate associated economic costs? Taxing tobacco, and using the money for tobacco-related research and other health-oriented purposes.

If only it were that simple. Actually, it is conclusively shown that higher tobacco taxes reduce use and provide funds for preventive and treatment efforts, but getting such taxes implemented is the complicated part. We call that “politics.”

Last year, the SFMS brought a policy to the CMA in support of the California Cancer Research Act, under the authorship of CMA trustee and former SFMS president Robert Margolin, MD. This policy was adopted, and CMA is now in support of Proposition 29, along with a long list of health organizations.

On the opposing side? The tobacco industry, of course, but in many guises. Here is just one example of one of its “front groups”: “Paid for by No on 29—Californians Against Out-of-Control Taxes and Spending. Major funding by Philip Morris USA and R.J. Reynolds Tobacco Company, with a coalition of taxpayers, small businesses, law enforcement, and labor.”  The “coalition” mentioned consists of a variety of interests bought and paid for by tobacco funds—even associations like the California Hispanic Chambers of Commerce have unfortunately been bribed with tobacco funds. Tobacco funds are paying for $15 million in television ads alone, and much more for anti-Proposition 29 propaganda, much of it recycled from previous specious arguments. 

California now ranks thirty-third among states in taxing tobacco. Clearing the tobacco-funded smoke to get California voters to see the wisdom of Proposition 29 will not be easy. But we agree with the Sacramento Bee, which recently editorialized that, despite some reluctance about the initiative process in general, “the potential benefits of raising the tobacco tax outweigh the uncertainties posed by Prop. 29 governance. And that’s the bottom line. To discourage smoking and save lives, California must again raise the tobacco tax. It must again overcome the specious arguments and hired guns of the tobacco barons.”

Vote yes on Proposition 29.

This article appeared in the May 2012 San Francisco Medicine President's Column.

This letter to the editor was printed in the May 8, 2012 San Francisco Chronicle. John Maa, MD is a SFMS board member and assistant professor of surgery at UCSF.

Big Tobacco's Big Bet

I applaud the courage of the editors of The Chronicle to endorse Proposition 29 (“A tobacco tax to save lives,” Chronicle Recommends, Insight, April 29).

Big Tobacco led a nearly $70 million effort to defeat Proposition 86 in 2006, with the result that California is currently only 32nd in the nation in per-pack cigarette taxes. Particularly effective in their successful campaign was the recruitment of physicians to appear on television speaking against the tobacco tax, a strategy that is being repeated in 2012.

I am deeply concerned by the misleading advertisements featuring Dr. Ladonna Porter, which prominently display her affiliation with the Golden State Medical Association and suggest that she is speaking on behalf of both that organization and the field of medicine. The truth is that both the National Medical Association (of which the Golden State Medical Association is a regional chapter) and the California Medical Association strongly support efforts to curb tobacco’s deadly toll.

The misrepresentation of Porter’s credentials is further evidence of the depth of manipulative efforts by the tobacco industry to confuse California's voters.

John Maa, San Francisco

According to the Centers for Disease Control and Prevention, smoking costs Californian taxpayers $9 billion every year in health care costs, and much more in lost productivity. This translates into smoking-caused costs of $15 per pack of cigarettes. And yet, at just 87 cents per pack, California's tobacco tax is one of the lowest in the nation.

That doesn’t make sense and, this June, Californians have the chance to do something about it.

Prop 29, the California Cancer Research Act, will benefit every Californian by lowering health care costs in the state, by enhancing California's economy, and by funding life-saving research that produces new diagnostics, treatments and cures for patients.

By adding $1 tax per pack of cigarettes and equivalent tax on other tobacco products, Prop 29 will save an estimated 104,500 lives from premature smoking-caused deaths, prevent 228,700 children from becoming adult smokers and save Californian taxpayers an estimated $5.1 billion in long-term health costs from declines in smoking.

What’s more, passage of Prop 29 will generate $735 million per year in total revenue. This money will be used to fund life-saving research on cancer and other tobacco-related diseases, and to support smoking cessation and prevention programs.

Please join SFMS, California Medical Association, American Cancer Society, American Heart Association, California Hospital Association, Stand Up to Cancer, and the University of California and vote YES on Prop 29.