Respiratory paediatrician Philip Pattemore responds to a suggestion that when people smoke they benefit society.
OPINION: According to joke lore, a man condemned in the French Revolution requested to be placed face up on the block so he could point out where the guillotine mechanism was getting caught, preventing it falling as it should.
Eric Janssen (Opinion: Why smokers are good for NZ society) - a ''moderate, considerate smoker'' - has done something similar in terms of tobacco tax legislation.
He has put his finger precisely on two questions that show where government smokefree policies fail to fall decisively on tobacco and health:
1) Are tobacco tax hikes primarily aimed at improving the health of the nation, or at bringing in revenue?
2) If it is to improve heath, is the nation healthier as a whole with the population growing older because there are fewer smokers?
I am not in government but I suspect the answer to the first question would depend on who you asked.
The Health Ministry would say there is strong evidence tobacco taxes work in reducing cigarette purchases.
This means fewer cigarettes will be smoked and the effect of nicotine addiction on the health and opinions of the populace will be reduced, allowing other smokefree measures to be enacted with more support.
But if smoking reduction or elimination is the primary goal, then, as most smokefree advocates have urged, the revenue collected from smoking should be targeted at the problem - helping people give up and preventing young people taking it up.
That way the taxes would be designed to make themselves redundant as smoking decreased.
I suspect if you talked to someone from Treasury, they would say the Government does not believe in ''tied taxes'' - taxes collected and targeted for a specific purpose. This means the Government can use any taxes anywhere it needs them to be used.
However, in so doing, the Government runs the risk of becoming addicted to tobacco tax.
This is why its smokefree initiatives may be at best ambivalent and at worst compromised.
I suspect this is what Mr Janssen calls ''double-dipping''.
The second question is a different one. In terms of health economics alone (including the effect of increased survival into pensionable age), studies of tobacco effects have variously shown positive, negative or neutral economic impacts on a country.
When loss of productivity due to smoking is included as well as the health costs, there is little doubt tobacco poses a large net economic cost to society.
But this again begs the question whether the primary reason for tobacco control is economic, or to improve health and quality of life.
When the effects of tobacco on children - which I see every day in my practice - are considered, there can be no ethical justification for perpetuating the habit.
Effects on children include loss of life in the womb or through cot death, premature birth, lung disease, infections in the ears, nose, throat and lungs, increased rates and severity of asthma, and many other effects on health and learning.
My workload as a respiratory paediatrician could be cut by up to 30 per cent if no child was exposed to tobacco smoke.
When you consider the unethical way in which the tobacco industry has plied tobacco as a cash crop to third world farmers, resulting in deforestation across Africa, India, China and Southeast Asia; when you consider how they use child labour in tobacco manufacturing plants, exposing children to inhaled tobacco material and processing fumes, you have to ask: what is the responsibility of a country like New Zealand?
The Government has a responsibility here to be, as Mr Janssen says, clear and ruthless in its policies and motives.
To the ''moderate, considerate smoker'', I say, although they may feel ''got at'' by smokefree policies, they are not the perpetrators.
Their addiction is enmeshed in the problems tobacco wreaks but I strongly suspect if they could live their lives again they would want to avoid becoming smokers.
They are, in that sense, pawns in the machinations of a huge corporate enterprise that won't let a little ethics muddy the waters of its multibillion-dollar industry.
The Government needs to be uncompromising and unswerving in its devotion, not to tobacco tax, but to the welfare of our nation and our children.
- Philip Pattemore is an associate professor of Paediatrics, at Otago University, Christchurch
- The Dominion Post
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