Doctors argue that arbitrarily excluding smokers does little to solve the problem, and that this type of healthcare discrimination could spread to other unhealthy groups.

Rarely in the medical field will anyone defend smokers, but three doctors recently published a perspective paper in the New England Journal of Medicine in defense of smokers who are arbitrarily screened out of jobs.

The authors—Harald Schmidt, Ph.D., Kristin Voigt, Ph.D., and Ezekiel J. Emanuel, M.D., Ph.D.—stated that while the move is both symbolic and an effort to lower health insurance costs for non-smokers, it is hypocritical for healthcare organizations to care for the sick while limiting their hiring practices based on a single risk factor.

“Many patients are treated for illnesses to which their behavior has contributed, including chronic obstructive pulmonary disease (COPD), heart failure, diabetes, and infections spread through unprotected sex or other voluntary activities,” they wrote. “It is callous—and contradictory—for health care institutions devoted to caring for patients regardless of the causes of their illness to refuse to employ smokers.”

Twenty-one states allow businesses to arbitrarily deny employment to smokers, while the other 29 have legislation preventing it. Many healthcare organizations—including the Cleveland Clinic and Baylor Health Care System—and businesses like Alaska Airlines, Scotts Miracle-Gro, and Union Pacific Railroad, have polices about not hiring smokers. The World Health Organization stopped hiring smokers in 2008.

Canadian tech company Momentous Corp. gained some attention recently for its unwillingness to hire smokers and its stated policy, “We drink. We swear. We don’t f—ing smoke.

Delray Beach, Fla., stopped hiring smokers for municipal work, citing an annual savings of $12,000 per year in insurance for each non-smoking employee hired.

The U.S. Centers for Disease Control and Prevention (CDC) states that cigarette smoking costs $193 billion per year—$97 billion in lost productivity and $96 billion in healthcare costs. Second-hand smoke costs an additional $10 billion.

However, if healthcare costs are the only consideration, why aren’t other groups also singled out for their unhealthy behavior?

While no company can be faulted for wanting to protect the health of their employees and discourage damaging behavior, if they begin screening applicants based solely on healthcare costs, applications from members of these groups are also headed straight for the shredder.

People Who Are Fat

Unlike a person’s smoking habits, a person’s weight is a taboo subject for discussion, but obesity increases a person’s risk of developing heart disease, type 2 diabetes, cancer, high cholesterol, high blood pressure, osteoarthritis, and more. The CDC estimates that obesity costs the country $147 billion annually.

People Who Drink Soda

Sugar-laden sodas contribute to diabetes and obesity so much that the American Heart Association claims that soda kills 180,000 people per year. That’s nothing compared to the 5 million deaths smoking causes each year, but you don’t have to die from obesity and diabetes in order to accrue high healthcare costs.

People Who Drink Alcohol

Sorry, Momentous, but excessive alcohol consumption causes 80,000 deaths per year and more than 1.2 million hospital visits, and it costs more than $223 billion annually. Better make sure no one at the company has more than five drinks on any one occasion (four for women).

People Who Drive Cars

Car exhaust pollutes the air, and recent research from UCLA shows that children who are exposed to high levels of traffic pollution in the womb are at a higher risk of developing rare pediatric cancers. That, and traffic pollution is as harmful for kids as second-hand smoke. Not to mention the fact that auto accidents cost the country $164.2 billion a year.

People Who Sit at a Desk

Unfortunately for office employees, the Mayo Clinic says that sitting for more than four hours a day increases a person’s risk of death—from any cause—by 50 percent and increases the risk of cardiovascular disease by 125 percent. Hopefully, no one at these companies sits at a desk.

A CEO would be lambasted in the press for deliberately not hiring people from these other categories, but there is no similar public sympathy for smokers.

Smoking is highly addictive, though public health campaigns have reduced smoking rates from 42 percent of U.S. adults in 1965 to 19 percent today.

The NEJM authors say considering that 69 percent of smokers want to quit but only three to five percent succeed without help, “it is therefore wrong to treat smoking as something fully under an individual’s control.”

Assistance programs to help employees quit have been proven effective at protecting not only the health of the individual employee, but also the financial health of the corporation.

“We believe that employers should consider more constructive approaches than punishing smokers,” the doctors wrote. “In hiring decisions, they should focus on whether candidates meet the job requirements; then they should provide genuine support to employees who wish to quit smoking.”