With three physicians in the U.S. House and one in the Senate, Louisiana has twice as many doctors in Congress as California — a state with almost nine times more people and 47 more congressmen.

They prefer to be addressed as “Doctor.” Their press releases and staff rarely say Rep. John Fleming or Sen. Bill Cassidy.

They’re all Republican, oppose the Affordable Care Act, and three of the four have taken campaign dollars from cigarette manufacturers.

For instance, Congressman Charles Boustany, R-Lafayette, has taken $96,100 — $28,100, or 1 percent of his contributions in this election cycle alone — from PACs and employees of the largest three cigarette manufacturers, according to the Center for Responsive Politics, of Washington, D.C.

A cardiothoracic surgeon, Boustany specialized in surgical procedures of the heart, lungs, esophagus and other organs in the chest. When asked why, as a doctor, Boustany would accept any money from an industry whose products cause diseases that he personally has treated, his press spokesman Jack Pandol responded: "Dr. Boustany is supported by a wide variety of industries because of his work to lower overall tax rates, simplify the tax code, reduce burdensome regulations, and put Americans back to work."

To be fair, Rep. Steve Scalise, R-Jefferson, is the Louisiana politician who has taken the most dollars from big tobacco. But he is not a physician and is the third-highest-ranking member of the U.S. House.

Republican Cassidy, a Baton Rouge gastroenterologist, received $5,000 in his 2014 run for the U.S. Senate. Fleming, another of the 24 candidates running the Senate this year, received $1,500 in 2010, but nothing since.

Fleming, who practiced family medicine in Minden, released a statement saying he has not actively solicited donations from the tobacco industry. “The overwhelming amount he has raised has been from individuals who donate to him because of his conservative convictions and record, not special interests who hope to buy his vote despite any personal reservations he would have about their product or industry,” said Matthew E. Beynon, his campaign’s spokesman.

Only Republican Rep. Ralph Abraham, who had practiced family medicine in Mangham, hasn’t received tobacco money. But that’s more because the U.S. House Lung Cancer Caucus member says he hasn’t really sought the money, rather than any hard objection to receiving those contributions from an industry whose products “have proven associated health risks,” his spokesman said.

Federal candidates are not the only recipients of tobacco largesse. In terms of total dollars donated to state-level politicians, Louisiana ranked sixth in the nation. Apart from a small triangle along the Mississippi River, Louisiana grows no tobacco.

Over the past decade, for instance, Richmond, Virginia.-based Altria Group, the world’s largest cigarette manufacturer (they make Marlboros and Virginia Slims), has donated $589,984 to Louisiana legislators. In the last election, 44 of the sitting 105 state lawmakers received money.

Altria’s media office did not respond to requests for comment last week.

While Louisiana may lead the nation in the number of doctors in Congress, the state also is considered the least healthy, according to America’s Health Rankings. And the annual survey says smoking is the number one reason for early death in Louisiana — more than obesity, way more than violent crime.

For Tonia Moore, who has been fighting for years to reduce smoking, the reason is plain. “It’s a lack of having a strong policy within the state,” she said.

Evidence shows that higher prices work far better than patches and gum for people wanting to quit smoking, said the associate director of the New Orleans-based Louisiana Campaign for Tobacco Free Living. But the effort to do that has had limited success — pushing state taxes up to $1.08 per pack. The national average is $1.61.

Back in the 1990s, when anti-smoking legislation was all the rage in Congress, some candidates refused tobacco money, including prominent senators at the time like Sam Brownback, R-Kansas, and Kit Bond, R-Missouri, according to The Washington Post. "You don't really want to be associated with an industry that consistently lied to Congress and the American people," U.S. Rep. Deborah Pryce, R-Ohio, told the Post in 1998.

But that was then.

Big tobacco’s donations don’t carry the same stigma anymore.

“As long as the elected officials know where that money comes from and what it means, then it’s a legal donation,” said Lydia Kykendahl, of American Cancer Society — Cancer Action Network. “Whether or not they should is entirely up to them.”

Follow Mark Ballard on Twitter, @MarkBallardCnb.