If Obama quits ... smoking

PRESIDENTIAL hopeful Barack Obama is trying to quit smoking. There are, of course, many good reasons to. He will significantly reduce his own risk of serious disease and that of those around him by not smoking. But clearly, one of the reasons Obama wants to quit now -- beyond pressure from his wife -- is that it would be widely perceived as unseemly and inappropriate to have a smoker in the White House.

Smoking has become a marginalized and often stigmatized behavior, a sign of personal weakness -- which just won't do in a presidential candidate these days. A once-social behavior has become largely solitary; the fragrant has turned foul. Indeed, we've had a revolution in the meanings associated with cigarettes that has coincided with a remarkable decline in smoking.

At the time of the first U.S. surgeon general's report issued in 1964, nearly half of all adult Americans were smokers. Today, the number stands at about one in five. Nonetheless, smoking continues to exact an enormous health toll. Nearly 450,000 deaths each year in the U.S. are attributed to cigarette use.

As Obama must know, quitting is no easy matter. Most individuals attempting it have tried and failed. Even those who get the best counseling and pharmacologic treatments are likely (at a rate of about 80%) to be smoking still, or again, at the end of a year.

And it may well be getting even more difficult to quit. A recent study shows that the average dose of nicotine in a pack of cigarettes has increased by more than 10% just since 1995, a result of explicitly engineered modifications.

Yet tobacco giant Philip Morris claims that it is eager to help smokers quit. It says so on its website and in much-touted "Quit Assist" ads and booklets that offer cessation strategies to smokers. This is the brilliant contemporary formulation of an old tobacco industry yarn: any smoker can quit if they are motivated and persevere.

So, even as tobacco companies admit that smoking is harmful -- a fact they denied for 40 years -- they continue to assert that consenting adults assume the risks (though they don't like to get specific about what those risks are, like lung cancer and stroke). As we now know from the millions of pages of internal tobacco documents available on the Web, the industry blows smoke out of both sides of its mouth. Philip Morris has been especially eager to complete its makeover into a "responsible corporate citizen." The company gave $25 million to the University of Virginia this month to support research on, yes, smoking cessation. Meanwhile, the five major U.S. tobacco companies, including Philip Morris, spent more than $15 billion last year promoting cigarettes here.