Last Friday the FDA decided to remove the black box warning it places on the smoking cessation drug Chantix. That the black box itself existed was a source of great frustration to me, because it represented the triumph of narrative over rational economic analysis. A few compelling stories, appearing in influential, widely read publications, created the impression that the drug causes hallucinations and bizarre behavior in a subset of individuals. These anecdotes were compelling enough to induce the FDA to place the warning on the box, which dramatically reduced sales.
This result, Devorah Goldman and I argued, was calamitous. Quitting smoking can be incredibly difficult for people, and there are few methods to do this that have been proven to be effective, with Chantix being one of them. To discourage people from using it means that more people will be smoking and exposing themselves to the risks inherent to tobacco. In effect, this decision almost assuredly increased the number of people who became ill due to smoking to prevent something that no solid evidence showed was true. In the last few months a major study came out that looked at the data and showed that the the rate of hallucinations or other, similar mental illnesses was no different for people who use Chantix than for the population at large. After the FDA digested the study and asked Pfizer—which paid for the study—for additional data, it removed the black box warning.
This is a rare opportunity for me to take a victory lap. One summer in graduate school, while attempting to avoid doing anything strenuous besides playing basketball, I was hit with a pang of protestant guilt and I volunteered to write for the editorial pages of Indiana University’s school paper, the Daily Student. Despite the politics of the editorial board members being slightly to the left I figured I could find a couple things we could all agree on.
My first piece was on why the school should move from its all-you-can-eat cafeteria system to an a la carte system, and I argued that doing so would encourage more sensible eating, less waste, and reduced costs. The next week the powers-that-be met in a special session and actually adopted my suggestion, citing me in the process.
My next piece suggested that the city of Bloomington charge people for garbage by the bag instead of a flat per-household fee, again suggesting that imposing a marginal cost would elicit more sensible behavior and save money. A week later the city actually did it, and my article was mentioned in that debate as well. I was starting to like this gig.
And thus endeth my impact on public policy for a very long time.
The paper’s editors then discovered my political leanings and I was summarily dismissed, and I went back to my studies and playing basketball. When I became a professor I latched onto an arcane issue related to the regulation of gasoline prices in the state of Wisconsin and rode it all the way to tenure, but the state legislature didn’t agree with me and actually strengthened the law I recommended be abolished. I then became an expert witness on the issue and paid for our wedding by doing so—giving me a lesson on how the policy game actually works, it turns out.
I then spent nearly a decade working for Congress, and the only positive change I can point from that tenure was getting the Senate cafeteria to carry barbecue sauce on days they made roasted chicken, and even that probably has more to do with my office mate than me. Nearly everything I worked on either got overcome by events, usurped by another committee, shot down by the White House, or died an ignominious death.
In the six years that I’ve been writing policy pieces I’m also hard pressed to find something I did that could reasonably be construed to have been a key factor in some policy decision. Until now.
The decision came eight years to the day after a good friend of mine named Rick Monce died of lung cancer, so this cause of smoking cessation became somewhat personal for me. I’m okay writing opeds that cause people to tell me I’m ignoring reality, or the workings of Congress, or the motivations of regulators, but more than anything else I’ve written on for some time I wanted to succeed on this one. And I am beyond pleased that it happened.
Christopher Caldwell wrote in these pages a few years ago that the anti-smoking attitude took a turn towards the moralistic, and the result is that there’s an unspoken attitude that people who come down with lung cancer from smoking somehow deserve it. It’s an understandable yet horrible way to approach the issue, and one I’ve been guilty of myself at times—until good people I cared for deeply suffered the ravages of smoking.
Thankfully, those people will be fewer in number in the future. And even though I undoubtedly don’t deserve a lick of credit, I’m going to celebrate a bit, and move on to my next cause.
