Smoke, Smoke, Smoke that Cigarette

Smoke, smoke, smoke that cigarette
Puff, puff, puff and if you smoke yourself to death
Tell St. Peter at the Golden Gate
That you hate to make him wait
But you just gotta have another cigarette.

by Merle Travis and Tex Williams

As my time winds down here in New Zealand and I prepare for my departure at the end of the month, I’m working hard on a few heavy-issue blog posts about topics like Maori/ Pakeha health disparities and New Zealand’s drift under the new National Party government towards some of the false solutions that resulted in the chaos that is American healthcare today. (Privatization, increased reliance on private health insurance, and judging by today’s new budget proposals and tax overhaul, tax cuts for the wealthy and the fallacy of trickle-down economics.)

But something else caught my eye in today’s Waikato Times, the daily newspaper from Hamilton. For the many of you who no longer read a daily newspaper and kid yourselves that you’re keeping up by grazing web-based content, this is another argument for sticking with print journalism. Today’s paper was full of good, juicy, healthcare related news. The front-page headline was “Patients’ Therapy on Track”, which catalogued the local Waikato DHB’s (District Health Board) progress in improving or attaining numerous health benchmarks ranging from immunization rates, wait times in the emergency room and access to elective surgery, to better diabetes and cardiovascular services. The good news is that the local DHB is doing better and better.

But what really grabbed my attention was one of the benchmark parameters called “better help for smokers to quit”. In NZ, there is real attention being paid to dealing with tobacco as a major driver of death and disability.

Digging even deeper into the newspaper on page 20 was another smoking-related article entitled “Tobacco Ban Rated Life Saver” which highlights a recent public health recommendation from the Otago University School of Medicine and Health Science, Wellington, that all commercial sales of tobacco be phased out by 2020.

I didn’t think that smoking would be one of my New Zealand blog topics, but it’s this kind of forward thinking that gets to the heart of effective public health intervention. After raising the pack price of manufactured cigarettes to over $15 New Zealand ($11 US) last month, a total ban is the natural next step in eliminating this health scourge.

This is a topic that has been near and dear to me ever since the start of my medical career in 1975, because I attended a private medical school in North Carolina called at the time, the Bowman Gray School of Medicine, which was affiliated with Wake Forest University in Winston-Salem, North Carolina, USA. And if you recognize the name of the city as two famous US cigarette brands, you’ll start to understand why I warm up to this topic. In point of fact, not only the medical school but the entire University was underwritten by the Reynolds and Babcock families of Winston-Salem, the owners of the RJ Reynolds Tobacco Co. I’m convinced that it was funded to assuage their collective guilt at profiting so handsomely from a product that so predictably and effectively kills people. It’s no coincidence that the medical school I attended was known for research in atherosclerosis and stroke. There certainly was no shortage of local patients suffering from these conditions as a result of their addiction to the local drug cartel’s product.

In fact, in the spirit of full disclosure, I didn’t escape North Carolina without being addicted myself. But after numerous attempts to quit I finally did and the only thing positive I can glean from the experience has been a credible understanding of what patients are going through who still struggle with smoking cessation. My all too intimate brush with the tobacco industry is also the source of the residual anger I feel at the lies, corruption, and blatant conflicts of interest that provided the institutional backdrop for my medical education.

Interestingly, the medical school has been renamed the Wake Forest University School of Medicine ( more whitewashing?) and to this day, they persist in sending me alumni updates and solicitations for financial contributions. I guess they don’t even read my responses to their solicitations because they keep sending me chirpy newsletters and they simply don’t seem to grasp that the institution is, to my way of thinking, forever ethically tainted.

But I am digressing. Back to the radical proposal: The blunt, get-to-the-point, common sense approach that I’ve come to expect from the Kiwis, comes through in a proposal simply to ban the stuff. In fact the thinking goes further. To limit black market trade, there is an endorsement allowing people to grow their own tobacco if they’re so motivated. It also helps that border control in an island nation is more enforceable than elsewhere.

Why are such measures important? Because young people are still very vulnerable to the glamorization and media manipulation that makes cigarette smoking “cool”. There is also a disproportionate number of Maori citizens here in New Zealand who smoke. Both groups would benefit greatly from significantly curtailed marketing of and access to tobacco. A manufactured tobacco ban would virtually eliminate the 5000 deaths that now occur annually in this country from cigarette smoking. This intervention alone is estimated by Prof.Tony Blakely at Otago University to be “the single most important and feasible action to reduce Maori mortality and ethnic disparities in this country”. Until 2020, additional phase-out strategies could include larger health warnings, a ban on tobacco displays in retail stores, no duty-free imports, and plain packaging (an intervention that Australia is seriously considering implementing in the near future).

It has now been over 15 years since I smoked my last cigarette, but in spite of that my cumulative lung cancer risk is still elevated. (But don’t tell my health insurance carrier, they might cancel me...) For me this issue is personal. Profit-seeking corporations like R.J. Reynolds tobacco sought to kill me with a toxic but “legal’ product. And I was young and stupid enough to think I was immortal or exempt. All the while, they and others like them continue to profit handsomely by peddling their lethal wares. And until now, the corrupt politicians from the killing fields of the Carolinas, Virginia and Kentucky defended the industry. It’s good to know that there’s one place where people are simply saying enough is enough. I truly hope the day will come soon (as I think it is already) when we view cigarette smoking as a bizarre artifact of the past.

Next up, now that we’ve touched on it, the reality of ethnic health disparities in New Zealand.