Tuesday, November 13, 2012

Killing 100 Million People

I'm old enough to remember smoking sections on airplanes, smoking in theaters, smoking in the doctor's lounge and even doctors smoking on rounds in the hospital.  Once I walked in the room of a patient who was 4 days following the removal of a lung cancer only to find three relatives smoking at his bedside.

In the early 1980's, we petitioned our hospital system to become non-smoking.  This was so radical that the hospital attorney stated, "I can't tell my secretary not to smoke at her desk!"  It thus was viewed and argued that this was an individual rights issue.  Fortunately though, about this time second hand smoke adverse health effects were coming to light. Within a year we became one of the first in the country to become tobacco free.

There was still push back and some contention - even some humorous incidents.  I walked into the ICU one afternoon and an RN said, "You're not going to believe what happened.  I walked into the call room to have a rest and found it full of smoke with a shadowy figure across the room.  So I bolted back to the ICU and called security.  When he answered, I told him what happened.  There was a moment of silence, then he said, 'I'm sorry, but that was me you saw!'"

The 20th century will be remembered for its 100 million tobacco related deaths in the USA.  The BBC has an excellent summary of just how the mechanizing and marketing of the cigarette led to the epidemic of tobacco abuse in the USA and worldwide.  Lung cancer was so rare in the early 20th century that medical students might never see a case - and would be called to view an autopsy when lung cancer could be viewed.

Smoking was cleverly and cynically marketed to women as a sign of sophistication and liberation.  Remember the ad "You've Come a Long Way Baby?" 

So what can we learn?  We all do like our rights - to smoke, get fat, drive fast, etc.  However these behaviors cost us as a society, and it's problematic how to find the appropriate role of governmental efforts to educate and regulate.  But since we all pick up the health care and economic impact, we're all interested parties.  It will be interesting to follow the attempts to reverse the obesity epidemic now facing this country which are fairly timid so far. 

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