Last century, before John Button was a little boy, many pubs and shops scattered sawdust all over their floors. This helped absorb mud, and blood and vomit in some of the more exuberant establishments. But the sawdust was also very handy for soaking up the constant gobs of phlegm that people would unblinkingly spit when and where it pleased them.

Clearing one’s throat and nose is undeniably pleasurable, as is farting – the indelicate subject raised by the dinner guest in John Button’s article. In Elizabethan England, flatulence was considered normal and not proscribed by considerations of politeness or offensiveness. There seems to be no history written on the cause of the demise of public farting, but public expectoration went by the boards when its role in spreading tuberculosis was suspected.

There are interesting similarities between spitting, farting and smoking in enclosed public spaces. Each is essentially personal and capable of being exercised in both private and in public. All three behaviours have emerged as the focus of social ostracism and, in the case of spitting and smoking, legal sanctions.

The pleasure these behaviours give to their perpetrators also causes unpleasant, and in the case of spitting and smoking, potentially harmful results to those exposed. In 1992 Mrs Liesel Scholem successfully sued her employer for $85,000 for the exacerbation of her asthma caused by occupational passive smoking. The US Environmental Protection Agency last year categorised cigarette smoke as a class-A carcinogen – meaning there was no safe level of exposure.

So where are the records of the spitters’ and farters’ rights groups? Did last century’s spitters howl about being labelled social pariahs when asked to go to the bathroom to clear their throats? Was there a Farters’ Rights Institute that sponsored tame ear, nose and throat specialists and gastroenterologists to correct misinformation being spread by those who like their air fresh? The critical difference between the three is that it is only smoking that involves a purchased commodity. With nothing to sell, there’s no financial gain to be made by a group like the tobacco industry in promoting social acceptability. Talk today of spitters’ rights might be appropriate to the clauses of a footballer’s code on on-field conduct, but greeted with derision anywhere else. Yet John Button alluded to the plight of smokers’ rights using language about Stalinism that insults everyone in medicine and public health who tries (and succeeds) now to prevent lung cancer.

When someone dies after a road crash, after eating a can of contaminated salmon or after an industrial accident, the death has a visibility that largely determines both private and public perceptions of what sort of death it was – whether it was avoidable, and the speed and style of response from government to prevent further similar deaths. The authority by which officials act to prevent further avoidable sudden deaths is testimony to the broad horror that we share about dying unexpectedly and to the unchallenged assumption that preventive action in such cases is a good thing.

Deaths caused by smoking tend to be quite different. In 1991, 1,739 men and 623 women in New South Wales died from lung cancer. Deaths caused by smoking almost always occur away from the public gaze. A death from lung cancer or heart disease in a smoker will often occur following a decline in health or previous attacks. Lung cancer deaths, while often taking only a few months from diagnosis to grave, conclude in hospitals and hospices, settings where deaths are expected.

Again unlike dramatic deaths, where the causal agent (like a speeding car) or environment (like a drunken party before a road crash) is obvious to all, smoking deaths can tend to perplex others. The person smoked all their life, and there at the funeral stand several others who have also smoked all their lives. Consequently, there is widespread incredulity at statements that smoking is the leading cause of death in industrialised countries.

Australian tobacco consumption has declined by more than a third since 1976, the year John Button’s Stalinists banned direct tobacco advertising on radio and television. Last year, sales were down by a record 6 percent in one year. Much of this is the flow-on from passive smoking: if people can’t smoke at work, they not only reduce the risk to non-smokers but reduce their own consumption. In 1978, William Hobbs, a president of the tobacco multinational R.J. Reynolds, said about anti-smoking measures: “If they caused every smoker to smoke just one less cigarette a day, our company would stand to lose $92 million in sales annually. I assure you that we don’t intend to let that happen without a fight.”

Part of this fight has been the astute cultivation of the civil liberties causes by the tobacco industry, replete with the sort of gratuitous name-calling that John Button exemplified. People who save one person from drowning or rescue another from a burning building are rewarded for bravery. Transplant surgeons like Victor Chang are valorised as secular saints. Yet by public health standards, Chang saved a tiny number of lives in a highly dramatic fashion, compared to the less obvious results of preventive health endeavours like those John Button so demeans.

The National Heart Foundation estimates that between 1968 and 1988, the falling death rate from heart disease in Australia has “saved” 115,144 lives. Analysis of the equally dramatic decline in coronary heart disease mortality in the United States between 1968 and 1976 attributes 54 percent of the decline to lifestyle changes (principally the reduction in smoking) and only 3.5 percent to bypass surgery.

Cancer and heart disease charities know that if they talk about breakthroughs in treatment when they shake their collection tins, the public digs deeper. If they ask for money to help fund large passive-smoking prevention campaigns, far fewer feel disposed to be generous.

John Button’s views seem certain to perpetuate this futile outlook.