True, the black market is a concern. But Canada must be doing something right with tobacco control: The country sustained an average 4.1 percent decline in smoking from 1983 to 2004.

http://www.bmj.com/cgi/eletters/330/7496/898

In areas with higher taxes, rates of smoking declined more rapidly:

http://www.cmaj.ca/cgi/reprint/156/2/187.pdf

Everyone of your appeals to increasing taxes on "sin" or "luxury" items is offset by black markets, which, occurred in Canada, with its draconian prices. Prices do serve a function, but targeting one group to pay for another group's policy objectives is itself the problem, regardless of the price mechanism.

I ordinarily wouldn't bother talking to a Tobacco Nazi, but i must express extreme displeasure at your desire to take money from smokers and give it to doctors. Thank goodness for Dubya, and I'll be voting Republican nest election.

According to the Institute of Medicine, increasing taxes on tobacco is one of the most effective ways to reduce smoking, particularly among children and adolescents. In their detailed report on the issue, they did not wave their hands at the problem--their recommendation is backed up by numerous studies.

Kids are more vulnerable to tobacco addiction than any other population, since the vast majority of addicts begin smoking when they are young.

The Institute of Medicine is not alone in its view. The President’s Cancer Panel this August also called for increases in tobacco taxes.

Shameful that President Bush has chosen to ignore the recommendations of his own panel, and oppose tax increases on tobacco. He vetoed the children’s healthcare bill this week again, despite a 2/3 majority vote in the Senate.

As far as taxing the poor, when it comes to cigarettes, I’m all for it. It is true that a tobacco tax would put an unequal tax burden on poor. That’s because tobacco puts an undue burden on the poor. People of lower socioeconomic status have particularly high smoking rates and cigarette taxes are also particularly effective at curbing tobacco use in this group.

According to the Institute of Medicine, high taxes should be one major facet of a two-pronged approach to tobacco control legislation. The other facet, they say, is widespread smoking bans—which have been effective at curbing smoking in New York City (see our editorial).

About that statement from our book reviewer:
I believe it’s fairly well established that people with mental health issues are more vulnerable than other groups to tobacco addiction. Half the population of smokers seems like quite a lot though. Speaking of studies, I’d like to see his numbers!!

I close with some quotes from tobacco companies, thanks to the Campaign for Tobacco Free Kids. Taxes scare tobacco companies far more than any televised chain-smoking emphysema victim:

• Philip Morris: A high cigarette price, more than any other cigarette attribute, has the most dramatic impact on the share of the quitting population...price, not tar level, is the main driving force for quitting.6

• Philip Morris: Of all the concerns, there is one - taxation - that alarms us the most. While marketing restrictions and public and passive smoking [restrictions] do depress volume, in our experience taxation depresses it much more severely. Our concern for taxation is, therefore, central to our thinking.

• Philip Morris: When the tax goes up, industry loses volume and profits as many smokers cut back

• RJ Reynolds: If prices were 10% higher, 12-17 incidence [the percentage of kids who smoke] would be 11.9% lower

• Philip Morris: It is clear that price has a pronounced effect on the smoking prevalence of teenagers, and that the goals of reducing teenage smoking and balancing the budget would both be served by increasing the Federal excise tax on cigarettes.

•Philip Morris: Jeffrey Harris of MIT calculated...that the 1982-83 round of price increases caused two million adults to quit smoking and prevented 600,000 teenagers from starting to smoke...We don’t
need to have that happen again.

At Nature Medicine we will be publishing a book review in January that is very relevant to the points you raise, Charlotte. The book review is written by Dr. Henry Lester, and he raises many interesting points about smoking and the tobacco industry. As just one example, he argues:

up to one-half of cigarettes consumed in advanced societies are smoked by people with mental health diagnoses, who may perceive benefits—stress reduction, cognitive enhancement and weight control—from nicotine. In my opinion, ‘sin taxes’ will eventually stall out as engines for smoking reduction, because for many addicts, nicotine as an admittedly imperfect ‘medication’ is still worth the price.

I also wonder if there is any hard data specifically looking at whether increasing cigarette taxes to the maximum (whatever that would be) would really help with teen smoking.

Welcome back. You've been missed.

I have serious objections to your attitude toward socially re-engineering public health on the backs of "some" people, rather than approach it collectively as a socially desirable objective.

First, I am not an advocate of tobacco. Second, I believe children, indeed, all people should have access to good medical care. Third, targeting one group (as in profiling) to pay for others a deplorable approach to political policy.

If a policy is socially desirable, then it is socially responsible for all of society to pay for it, not to play reverse Robin Hood, tax the already burdened with more taxes, because someone can use the punitive tax to pay for a social policy others don't want to pay for.

We have a substantial population with surplus wealth collecting interest in banks, but let's not ask them to pay for children's health care, let's tax the smoker who is highly likely to be the recipient of the social benefit you just took from her pocket to pay for the service she cannot afford.

If a socially desirable project is really that socially desirable, ALL OF US should contribute to its implementation, not charging it to "others" -- as long as the other is not "me."

let me just say that I think the ideas you mentioned above about a scientific perspective on aspects of child-raising fills a interesting but totally neglected niche, and I'd love to see you write profusely about that.

So much of the "information for new parents" comes from either a stodgy 1970s "drink your milk for strong bones" perspective or a crazy helicopter mom "OMG chemicalz are teh badness!!1!" prespective. There's little sane, science-minded commentary available.

On a related note, I found this fascinating.