The Vatican is the only place I know where evidence of smoke can signal positive job news. Instead, as paired essays in the New England Journal of Medicine attest, employers are increasingly searching for evidence of tobacco smoke in job seekers to deny them jobs.
The authors of those essays neatly lay out opposing arguments to either support or denounce hiring policies that exclude smokers from employment consideration. Their thoughtfulness, civility, and adherence to actual facts provide a refreshing break from the smoke-blowing in much of the current public debate.
Tobacco use is viewed as the foremost preventable cause of death within the U.S. The Centers for Disease Control and Prevention claims that each year about 443,000 (or one in every five) deaths are caused by cigarette smoking and secondhand smoke exposure. Tobacco use also accounts for substantial disease and disability, heightening risks for cancers, stroke, heart problems, and lung diseases.
Understandably, tobacco's daunting human toll is of great economic concern to health insurers and employers. A sicker, less productive workforce can jeopardize a company's success. According to federal estimates, employers incur additional annual costs of about $3,400 per smoker. And nationally, the CDC attributes about $97 billion in lost work productivity plus $96 billion in health care expenditures to cigarette smoking alone.
Consequently, it's easy to see why some employers might wish to exclude smokers from their workforce. Already, for years, several large companies like Alaska Airlines and Union Pacific have adopted hiring policies that ban smokers. Some job applications actually entail requirements to pass urine tests that detect nicotine.
Appearing to lead this trend, hospitals and health care companies have been particularly aggressive about implementing strict "tobacco-free hiring" policies. Eminent institutions such as the Cleveland Clinic, World Health Organization and American Cancer Society uphold them as evidence of their sincere commitment to promoting health.
Some health-minded organizations view such hiring practices as ethical and dutiful strategies that can save lives and reduce health care costs by influencing social norms that discourage smoking.
And yet, on the other hand, the prevailing social norm in America actually embodies strong disapproval of hiring biases against smokers. A 2011 Gallup poll revealed that more than eight in 10 Americans believed it wasn't right for companies to refuse to hire people just because they smoked.
Opponents of tobacco-free employment policies also contend that hiring biases against smokers are particularly harmful to people in lower socioeconomic groups, among whom tobacco use and joblessness are more prevalent. They see an egregious lack of reason and compassion in further punishing people who are suffering an addiction -- especially an addiction to nicotine, which is notoriously difficult to kick.
Indeed, CDC data indicate that in 2010 nearly seven of every 10 smokers wanted to quit, and more than 50 percent attempted to do so. And despite this overwhelming desire and effort, multiple studies consistently demonstrate that precious few smokers ever succeed. As Mark Twain observed, "It's easy to quit smoking. I've done it hundreds of times."
Meanwhile, clinical research has outright failed to enlighten us about the legitimate efficacy of medical treatments that are heavily marketed to this vast consumer audience of smokers wishing to unhook from their nicotine dependence.
A major part of the problem involves the idiosyncratic ways in which researchers variously define the "success" of a treatment. For some, it can be one or two or 10 fewer smoked cigarettes -- per day or week or lifetime. For others, it's one or two or 10 fewer days of smoking -- within a month or year or millennium.
Clearly, in this case, one actually can -- and should -- argue with "success." And we should question whose interests are being served by the costly state of our confusion.
On that cue, it's often illuminating to identify the funding source of any research. While establishing that may not prove a biased interest in generating self-serving results, it can make you more appreciative of the creative ways in which science sometimes proves artful.
Last year, for example, two studies produced opposite claims about the value of nicotine replacement patches. One, published in the journal Addiction, claimed that continued use of the patch could help smokers overcome initial lapses; its authors were paid consultants to the pharmaceutical company that marketed the patch and funded the study. The other study -- published in Tobacco Control, funded by the National Cancer Institute, and conducted by academic researchers -- contrarily concluded that nicotine patches were useless in helping smokers quit long-term.
The bottom line is that smoking is extremely addictive and unhealthy, and the majority of smokers wish to be free of their addiction all the while they're kept in the dark about what does and doesn't help them succeed.
In the end, denying a job to a smoker is making a molehill out of a mountain of troubling concerns involving tobacco commerce and regulation. And providing a smoker with employment that requires her to spend eight-hour days in a tobacco-free workplace may prove to be the most successful and humane treatment of all.
Kate Scannell is a Bay Area physician and the author, most recently, of "Flood Stage."