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Sydney Uni boffin wants database to track smokers

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Open access journal PLOS Medicine has staged a debate on the topic of licenses for smokers.

The advocate of the case for a licence, Simon Chapman, is Professor, Director of Research and Associate Dean of the University of Sydney’s School of Public Health, argues that prescriptions are a temporary licence to possess and use certain drugs and that “In contrast to the highly regulated way we allow access to life-saving and health-enhancing pharmaceuticals… there would seem to be a case for redressing this bizarre but historically based inconsistency” that tobacco requires no licence to purchase.”

Chapman’s proposed licence would see smokers issued a smartcard, without which it would be impossible to buy cigarettes. Purchases would not be possible without swiping that card at point of sale. Chapman imagines those sales would be recorded in real time in order to enable a pre-commitment scheme limiting the number of cigarettes an individual could make in a fixed time period. Licences would cost more depending on how much one wishes to smoke.

Registration for the licence would be online, as this would allow the government to capture and email address and, by monitoring cigarette purchasing habits, send smokers emails prompting them to quit.

Chapman also believes such a scheme would produce useful data for health authorities, and imagines the following scenario:

“Every time a sale was transacted, data of high specificity would be added to the national database. These data would enable both immediate and longitudinal national, regional, and local monitoring of tobacco sales in ways that could provide invaluable information about smoker responsiveness to tobacco control initiatives as well as industry price discounting and new brand launches. Such information would be of great assistance to policy and program planners wanting to maximize cessation.”

Chapman pre-empts the argument about governments not belonging in cigarette packets by writing “Opponents of the idea would be quick to suggest that Orwellian social engineers would soon be calling for licenses to drink alcohol and to eat junk food or engage in any ‘risky’ activity.”

That argument, he says “rests on poor public understanding of the magnitude of the risks of smoking relative to other cumulative everyday risks to health.”

The scheme is not all stick and no carrot, as Chapman also imagines smokers could receive the combined value of their licence fees, plus interest, six months after they quit. Licence fees left in the fund by smokers who never quit would fund the scheme, which could doubtless provide employment for a good few Reg readers given the scale of the kit required to serve the millions who light up every day.

The case against is prosecuted by Jeff Collin of the Global Public Health Unit at the School of Social & Political Science at the University of Edinburgh.

Collin’s counter-argument says that the kind of licence Chapman proposes is technically achievable. He notes that in nations where digital ID cards are used “linking tobacco purchases to such cards may be largely unproblematic technically or politically.” Nations without such cards won’t be able to get them just to get a smokers’ licence up and running.

“In the United Kingdom, for example, successive governments have failed to introduce identity cards,” Collins writes. “If it’s very difficult to envisage health advocates securing support for a comparable scheme on the basis of a public health rationale, it is still harder to see why they should wish to.”

He also points out that a licence would hurt poor smokers more than rich smokers, which isn’t just, and is uncomfortable with the stigma a licence would create. “The proposal to require licenses will inevitably be widely perceived as demeaning, onerous, and punitive,” he says.

While the ethical merits of this idea are well and truly up for grabs, it is worth noting that Australia’s Northern Territory has already done something rather similar, in the form of a Banned Drinkers Registry aimed at preventing alcoholics from drinking in public. The scheme saw all buyers of take-away alcohol compelled to present identification – usually a driver’s licence - at the point of sale. Buyers on the banned list were denied service.

The scheme operated for just a few months, with a change of government rather than technical issues its downfall. ®

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