Help Wanted. No Smokers Need Apply: A New Marketplace Podcast

(Photo: Julie Bocchino)

Our latest podcast is called “Help Wanted. No Smokers Need Apply.”  (You can download/subscribe at iTunes, get the RSS feed, listen via the media player above, or read the transcript.)

In many states (21, to be precise), it is perfectly legal for an employer to not hire someone who smokes. This might seem understandable, given that health insurance is often coupled to employment, and since healthcare risks and costs are increasingly pooled. And so: if employers can exclude smokers, should they also be able to weed out junk-food lovers or motorcyclists — or perhaps anyone who wants to have a baby?

That question is the thrust of this podcast, which features a conversation with Zeke Emanuel. He is a Penn medical professor/bioethicist; a former White House healthcare adviser; the author of Healthcare, Guaranteed (and Brothers Emanuel, about growing up with Rahm and Ari); and a coauthor, with Harald Schmidt and Kristin Voigt, of a recent New England Journal of Medical article (previewed on our blog) called “The Ethics of Not Hiring Smokers”:

EMANUEL: I’m a cancer doctor. I find smoking disgusting. I find smoking horrible. I wish that everyone who did it could quit. But I also recognize that it’s not voluntary, that most people start before they’re adults and that it’s incredibly hard to quit once you’ve started.”

Emanuel also appeared in an earlier Freakonomics podcast, “Is the Obesity Epidemic for Real?” In this podcast, he argues that not hiring smokers lies somewhere between discriminatory and unethical. Give us a listen and let us know your thoughts.

Audio Transcript

Kai RYSSDAL: Time now for a little Freakonomics Radio.  It’s that moment every couple of weeks we talk to Stephen Dubner, the co-author of the books and blog of the same name.  It is “the hidden side of everything.”  Dubner, long time, no talk, man!

 

Stephen J. DUBNER: Great to be back, Kai.  Thanks for having me.  I know you trained as a Navy pilot -- I wonder if you ever thought about afterward working as a commercial pilot?  Was that ever a plan?

 

RYSSDAL: No, not really.  That was never my thing.

 

DUBNER: Well, if you had, and if you had interviewed with, let’s say, Alaska Airlines, there’s something you would have needed to know. Here’s airline spokesperson Marianne Lindsey:

 

Marianne LINDSEY:  “In general, there’s a question that’s asked, ‘have you smoked or used tobacco products within the last six months?’  And we go by how the employee responds to that question.  And then, before they’re hired, they have a drug test that they take that detects nicotine use.

 

RYSSDAL: So Alaska Airlines would not hire me, were I a smoker.  Yes?

 

DUBNER: Alaska Airlines would not hire you if you were a smoker.  Now, they’ve had this policy for quite a few years.  And more and more companies now are refusing to hire anyone who uses tobacco -- a lot of healthcare firms, especially, and hospitals.

 

RYSSDAL: This has to be about cutting healthcare costs, right?

 

DUBNER: That’s a primary reason, for sure. Smokers are more expensive than non-smokers, if you’re the company.  By one estimate, about $4,000 a year more in terms of healthcare and lost productivity and so on. But there’s also the idea that you want to make every workplace healthier, which means smoke-free seems to be a good idea there.

 

RYSSDAL: Right, OK.  That makes sense.  Question number two, though, Dubner, is this: Last time I checked, smoking is legal, man.

 

DUBNER: Yes it is.  So, as it turns out, in terms of the legality of hiring smokers: 29 states have passed laws that don’t let companies turn down smokers, but the other 21 states do allow you to do that.  So if I’m a company in New York or North Carolina or California, I cannot reject an employee because he or she smokes. But if I run a company in Pennsylvania or Florida or Alaska, I can. So that’s a pretty severe split – which recently led to a piece in the New England Journal of Medicine about the ethics of not hiring smokers. Here’s one of the authors, Zeke Emanuel, who is a bioethicist and a professor at the University of Pennsylvania.

 

Ezekiel EMANUEL: “I’m a cancer doctor. I find smoking disgusting. I find smoking horrible. I wish that everyone who did it could quit.”

 

DUBNER: All right.  So it’s not hard to think that he’s in favor of not hiring smokers. Right?  But wait, there’s more:

 

EMANUEL: “But I also recognize that it’s not voluntary, that most people start before they’re adults and that it’s incredibly hard to quit once you’ve started.

 

RYSSDAL: OK, wait.  “Not voluntary?”  I mean, Zeke Emanuel is a smart guy and all, but huh?

 

DUBNER: That is really the basis of his argument – which is that most smokers want to quit, but can’t, and to refuse to hire them is therefore discriminatory or at least unethical.

 

RYSSDAL: Does this break down on socioeconomic lines?  Is there a low-income, low-wage worker versus high-wage, high-income person thing?

 

DUBNER: Yeah, that’s a great question.  So low-income people are substantially more likely to smoke than high-income people across the board. So, if you’re a low-income smoker and now can’t get a job because you smoke, it’s sort of a double jeopardy. But there’s also the fact that smoking is one of those activities – legal, as you noted, but publicly frowned upon – that seems to open a bigger can of worms in terms of hiring. Here’s Emanuel again:

 

EMANUEL: “Once you’re on this kick, you can say, ‘Look at those Seventh Day Adventists!  They’re the people we really want to employ because those guys -- they don’t smoke, they don’t drink, they eat very healthy, they don’t engage in high-risk sporting activities.’ That just seems to me exactly where we don’t want to be going

 

DUBNER: So Kai, you can imagine a future where nobody wants to hire anybody who does anything at all risky.  Maybe not even risky, but just expensive -- like becoming pregnant and having kids. Because, as we all increasingly share healthcare costs, that means that you increasingly are thinking about what I do because it affects what you’ll pay in insurance and taxes. In the case of smoking, it’s really all about the incentives.  In a tough labor market like ours, will it turn out to be that getting a job is a such a strong incentive that it might help a smoker who has tried everything, but everything else else has failed? I have no idea if that will work, but it will sure be worth keeping an eye on.

 

RYSSDAL: Stephen Dubner.  Freakonomics.com is the web site.  Stephen, we’ll see you in a couple of weeks.

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COMMENTS: 59

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  1. Iljitsch van Beijnum says:

    Hidden due to low comment rating. Click here to see.

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    • Rusty Shackleford says:

      The same way existing drinkers will all die from cirrhosis and never be replaced. I find smoking a far less disgusting habit than hiring practices based mostly on a sense of moral superiority instead of merit.

      Well-loved. Like or Dislike: Thumb up 38 Thumb down 8
    • ERLW says:

      I’ve never observed a lack of sound judgement from my colleagues who smoke (other than the fact they smoke…); I appreciate that’s just anecdotal evidence, but it strikes me that there are a myriad of ways that we all regularly demonstrate unsound judgement in our daily lives. Like burning the toast, crossing the street without looking both ways, telling the girlfriend “It’ll just be one beer with the lads”… none of which would be relevant during a job interview. And I’m still not convinced smoking is a problem when recruiting unless (a) working with kids or (b) a demonstrable reason the smoker can’t do the job i.e. working in a “clean” room.

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    • Julien Couvreur says:

      As much as I dislike smoking, I don’t agree that it displays unsound judgement. Instead I recognize and respect individuals’ preferences.

      I don’t think the primary reason for this hiring policy is because of evaluation of the applicants skills, but rather because of the economic incentives of healthcare burden in current system (as this podcast claims).

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  2. Pedro Albuquerque says:

    I smoke Habanos with great pleasure and have never been addicted. In fact, right now I haven’t smoke for ten days because of a cold. Cigars are great with espresso coffee and Porto wine. Smoking a good cigar is a high point of my day.
    I’m also an ethical vegetarian, exercise, have ideal BMI, and have excellent health for my age.
    So let’s exchange it for a while: companies stop worrying about smokers (after all there aren’t many of us these days) and go face the real problem: getting rid of carnivores, right away!
    Or maybe you would prefer a truce: keep your greasy hands out of my cigars, and I promise you that I’ll keep my smoky hands out of your steaks.

    Hot debate. What do you think? Thumb up 16 Thumb down 12
  3. Mark Jean says:

    “Prohibition goes beyond the bounds of reason in that it attempts to control a man’s appetite by legislation and makes a crime out of things that are not crimes. A prohibition law strikes a blow at the very principles upon which our government was founded.” ~ Abraham Lincoln December, 1840

    Well-loved. Like or Dislike: Thumb up 22 Thumb down 4
  4. Eric M. Jones says:

    A perfect example of the argument by “False Equivalence”.

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  5. Al says:

    An employer should be able to hire whoever they want for any reason. This is the basis of a free society with voluntary interactions. An employer will ultimately hire someone for the value they provide regardless of behavior as long as it is morally neutral like smoking. Anytime a law or regulation is introduced, we have allowed another element of coercion and force into our lives.

    Well-loved. Like or Dislike: Thumb up 17 Thumb down 4
    • Rusty Shackleford says:

      Assuming perfectly rational hiring practices, perhaps. Turning down potential employees based solely on whether or not they smoke is irrational, but unlikely to cause enough harm to the company for it to change its policy. A problem that won’t self-correct seems to be a good reason to regulate.

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      • Enter your name... says:

        But they’re not actually “turning down potential employees based solely on whether or not they smoke”. It’s not like they’re saying “I need to hire 12 people, and here are the only 12 qualified candidates… Oops, he’s a smoker, so I guess I can’t fill that last slot.”

        They’re actually saying, “I need to hire 12 people, and here are hundreds of qualified candidates… How can I make this pile of applications smaller, and ideally get employees who cost less overall and miss fewer days of work into the bargain?”

        Well-loved. Like or Dislike: Thumb up 23 Thumb down 0
      • Bri says:

        @Enter your name
        I question whether you listened to the podcast or not because your example isn’t even remotely similar to what’s happening. The company is actually doing drug testing for nicotine as a basis for employment. Not to mention if you are asking someone whether they smoke or are a smoker you’re already in the interview stage. Usually people don’t put that info on their resume.

        And btw, in your example substitute “smoker” with “person in a wheelchair” and you’ve now just broken the law.

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      • Al says:

        Rational or irrational, it is the employer’s freedom to choose and decide how to run their business. Are you saying that business owners don’t know what’s in their best self interest and that the State always knows best?

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      • Babbo says:

        @Al:
        That’s a false choice. Business owners may know what’s best in their own self interest, but left completely to their own devices, business owners will discriminate in hiring on the basis of things like race, gender, age and religion, which we have weighed the costs of as a society and imposed regulations on. The balancing act of business owner vs state is already there. Tobacco use and employee health are just new criteria to consider as the labor market evolves.

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      • ERLW says:

        @enter your name

        Do you have any data to back up your quote that smokers miss more days of work? Not contesting it, just interested.

        My (anecdotal) observation of colleagues suggests there is no correlation. Certainly the ones who seem to take consistent and long sick leave aren’t smokers.

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      • Al says:

        @Babbo
        Could you please explain “we have weighed the costs of as a society” in more detail please? I’m not sure I understand what you mean.

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      • Enter your name... says:

        Bri, when you publicize your ‘we don’t hire smokers’ policy, you’ve effectively reduced your application pile.

        ERLW, the podcast says “Smokers are more expensive than non-smokers, if you’re the company. By one estimate, about $4,000 a year more in terms of healthcare and lost productivity and so on.” Lost productivity isn’t just taking a ten-minute smoke break several times a day. It was generally accepted in HR back when I worked in that field that smokers take one sick day per year more than non-smokers. You could look at medical studies like http://www.ncbi.nlm.nih.gov/pubmed/15694961 for more current information.

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      • belsha says:

        It’s amusing that “Enter your name”, to proove that smokers do cost more healthcare and take more sick days of, links to a study that he apparently hasn’t read (apart from the headline or the conclusion), because the study is so absurd, that he wouldn’t have endorsed it had he read it:

        http://www.ncbi.nlm.nih.gov/pubmed/15694961

        While the study shows that in the tiny sample of 292 health-care workers in Teneriffa, smokers did indeed take more sick days of, they also didn’t find any correlation with respiratory diseases (which could be smoking related), but only with “back pain”, which obviously has no relation — be it causal or only correlational — with smoking at all. So this is probably a statistical fluke due to the very small sample size, or perhaps there is some reason why people who smoke also happen to be people that take – possibly unwarranted – sick leaves because of “back pain” (in my opinion, it could actually be true that smokers take more sick leaves, considering that a huge proportion of mentally ill people smoke. Sick leaves for depression and anxiety thus would be much more common in smokers, but the cause would not be the smoking, rather the depression and anxiety would be the common cause of both the smoking and the sick leaves).

        This does not deter the authors from concluding: “Smoking is associated with a higher risk of sickness absence among healthcare workers, particularly due to back pain. This could be used as an incentive to persuade healthcare workers to stop smoking and re-inforce the non-smoking message given to their patients.”

        It clearly doesn’t matter to them that there is no association between smoking and the ailment this people take sickness absence. The only thing that matters to them is that their “study” might encourage heath care workers to stop smoking and thus “re-inforce” the “non-smoking message”.

        The problem with so many claims of tobacco control is that it is based on so incredibly shoddy science, who’s only aim is to amplify a message to change behaviour.

        So, sorry “Enter your name”, to convince me that smokers in working age take more sick leaves, you better link to some more convincing studies.

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  6. Carol Denney says:

    Great piece! But one crucial element was left out — smokers, unlike women, or members of an ethnic group, are NOT a protected class. Quitting may be difficult, but people do it all the time and it can be done.

    Your piece seemed to equate discrimination against women for potential pregnancy with “discrimination” against smokers, and it is not legally possible because smokers can become nonsmokers a lot more easily than the rest of us can change race, gender, or turn in our cardiovascular systems for something that can tolerate secondhand smoke. Thanks,

    Carol Denney

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    • Byung Kyu Park says:

      If the pregnancy example is a bad one, what about hiring practices against people who are obese? Or hiring practices against people who cannot work, for example, Friday evenings (usually for religious reasons)?

      Fat people can become thin; Orthodox Jews can convert to another religion (or just stop practicing).

      The real question is should there really be *any* categorical description (that doesn’t imply law-breaking) that preemptively disqualifies a person from a job—especially when that category doesn’t relate to job performance?

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      • Enter your name... says:

        Except that smoking *does* relate to job performance, since the podcast says smokers cost the company $4,000 a year in lost productivity and higher costs compared to non-smokers. “Lost productivity” means “worse job performance”.

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      • Bri says:

        @Enter your name,

        That stat was taken out of context. They didn’t explain where the number came from or what caused it.

        I’ve seen numerous studies that show that lifetime healthcare costs for smokers are less than non-smokers, mostly because they simply die early. Whether this has any effect on a company’s bottom line is another question. I’m sure they’re more interested in the short term gains, but having an employee just die at 50, for example, would seem to me to be fairly detrimental to overall costs.

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    • ERLW says:

      But why should they have to quit?

      It’s legal (isn’t it?).

      Thumb up 3 Thumb down 1
  7. Janice Koch says:

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    • Brian says:

      Except that you have now backed yourself into a discrimination corner. Why discriminate against nicotine drug use vs caffeine drug use. As long as you can do your job, what you do at home is your own business.

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      • Pshrnk says:

        Caffeine does not have the same effects on alergy sufferers around you. In fact I would argue it is a reasonable accomadation for my asthma that smokers be kept away from my work place.

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  8. Babbo says:

    I can see both sides of this argument in the immediate employment context, and both sides have legitimate points. However, in the broader, macroeconomic context of employment, health and healthcare reform, I worry that normalization of these kinds of hiring policies could effectively act as a wedge to further marginalize the underclass and exclude them from the kind of assistance the Affordable Care Act is meant to provide. The sanctimonious way some Americans have taken to scapegoating sick and unhealthy Americans for problems with our healthcare system in recent years concerns me tremendously, and as part of health care reform I think it’s only fair to have this conversation and consider the ramifications if employers are allowed to discriminate in their hiring practices based on employee health.

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