From Smoking Boom, a Major Killer of Women

By DENISE GRADY

New York Times

Published: November 29, 2007

http://www.nytimes.com/2007/11/29/health/29lung.html

Impacts of Smoking• For Jean Rommes, the crisis came five years ago, on a Monday

morning when she had planned to go to work but wound up in the hospital, barely able to breathe. She was 59, the president of a small company in Iowa. Although she had quit smoking a decade earlier, 30 years of cigarettes had taken their toll.

• After several days in the hospital, she was sent home tethered to an oxygen tank, with a raft of medicines and a warning: “If I didn’t do something, life was going to continue to be a pretty scary experience.”

• Ms. Rommes has chronic obstructive pulmonary disease, or C.O.P.D., a progressive illness that permanently damages the lungs and is usually caused by smoking. Once thought of as an old man’s disease, this disorder has become a major killer in women as well, the consequence of a smoking boom in the 1950s, ’60s and ’70s. The death rate in women nearly tripled from 1980 to 2000, and since 2000, more women than men have died or been hospitalized every year because of the disease.

Figures

COPD• Chronic obstructive pulmonary disease (COPD) actually comprises two

illnesses: one, emphysema, destroys air sacs deep in the lungs; the other, chronic bronchitis, causes inflammation, congestion and scarring in the airways. The disease kills 120,000 Americans a year, is the fourth leading cause of death and is expected to be third by 2020. About 12 million Americans are known to have it, including many who have long since quit smoking, and studies suggest that 12 million more cases have not been diagnosed. Half the patients are under 65.

• The disease has left some 900,000 working-age people too sick to work and costs $42 billion a year in medical bills and lost productivity.

• Experts consider the statistics a national disgrace. They say chronic lung disease is misdiagnosed, neglected, improperly treated and stigmatized as self-induced, with patients made to feel they barely deserve help, because they smoked. The disease is mired in a bog of misconception and prejudice, doctors say. It is commonly mistaken for asthma, especially in women, and treated with the wrong drugs.

Smoking as an addiction

There are lots of models. One that has become popular isthe “rational addiction” model. It is powerful and useful.Be aware, however, that it is only one of several modelsand not all economists, and CERTAINLY not all addictionresearchers believe in it in its entirety.

Reinforcement and Tolerance

• Addictive behavior is usually assumed to involve both “reinforcement” and “tolerance.”

• Reinforcement means that greater past consumption of addictive goods, such as drugs or cigarettes, increases the desire for present consumption.

• But tolerance cautions that the utility from a given amount of consumption is lower when past consumption is greater.

Consider instantaneous utility

(1) U(t) = u[c(t), S(t), y(t)]

U(t) = Utility at time tc(t) = Consumption of addictive good at time tS(t) = “Addictive capital stock” that depends on

past consumption of c.

Tolerance implies that dU/dS < 0. Greater past consumption ofaddictive goods lowers current utility. Stated differently, Higher c(t) lowers future marginal utility by raising future values of S.

Consider instantaneous utility

(1) U(t) = u[c(t), S(t), y(t)]

U(t) = Utility at time tc(t) = Consumption of addictive good at time tS(t) = “Addictive capital stock” that depends on

past consumption of c.

Reinforcement implies that dc/dS > 0. Greater past consumption ofaddictive goods raises MU of current consumption.

Myopic users – condition above is sufficient.

Rational maximizers – Also consider the future harmful consequences of the current behavior.

Consider instantaneous utility

(1) U(t) = u[c(t), S(t), y(t)]

U(t) = Utility at time tc(t) = Consumption of addictive good at time tS(t) = “Addictive capital stock” that depends on

past consumption of c.

Rational maximizers – Also consider the future harmfulconsequences of the current behavior.

For rational maximizers , reinforcement requires that the + effectof an increase in S(t) on the MU of c(t) exceeds the - effect ofhigher S(t) on the future harm from greater c(t).

Implications

• It is not surprising that addiction is more likely for people who discount the future heavily since they pay less attention to the adverse consequences.

• Addiction to a good is also stronger when the effects of past consumption depreciate more rapidly, for then current consumption has smaller negative effects on future utility.

• The harmful effects of smoking, drinking, and much drug use do generally disappear within a few years after a person stops the addiction unless vital organs, such as the liver, get irreversibly damaged.

When A is above the steady state line, both C and S grow. Both fall, when A is below the steady state line

When A is above the steady state line, both C and S grow. Both fall, when A is below the steady state line

Addictive Stock and Consumption

Stock, S

Consumption, C

S0 S1 S*1

C*1

C1

C2

S2 S*2

C*2

Steady State!C = S

Steady State!C = S

A1

A2

Initial Stock = S2

Depends on past consumption and life-cycle.

If S0 is below S1, a rational consumer eventually stops.If S0 is above S1, a rational consumer may go to S*1.

If S0 is below S1, a rational consumer eventually stops.If S0 is above S1, a rational consumer may go to S*1.

Addictive Stock and Consumption

Stock, S

Consumption, C

S0 S1 S*1

C*1

C1

C2

S2 S*2

C*2

C**

Steady State!C = S

Steady State!C = S

A1

A2

Impact of price change

• To analyze rational addicts’ responses to change in prices of an addictive goods, suppose they are at c*2 = δS*2 along A2, and that a fall in the price of c raises the demand curve for c from A2 to A1.

• Consumption increases at first from c*2 to c**, and then c grows further over time since cc** is above the steady-state line. Consumption grows toward the new stable steady state at c*1 = δS*1

• This shows that long-run responses to price changes exceed short-run responses because initial increases in consumption of addictive goods cause a subsequent growth in the stocks of addictive capital, which then stimulates further growth in consumption

Addictive Stock and Consumption

Stock, S

Consumption, C

S0 S1 S*1

C*1

C1

C2

S2 S*2

C*2

C**A1

A2

To analyze rational addicts’ responses to change in prices of an addictive goods, suppose they are at c*2 = δS*2 along A2, and that a fall in the price of c raises the demand curve for c from A2 to A1.

Consumption increases at first from c*2 to c**, and then c grows further over time since c** is above the steady-state line. Consumption grows toward the new stable steady state at c*1 = δS*1