“Preventable” vs the 18%

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John Dabrowski, LICSW
Neponset Health Center and Geiger Gibson Community Health Center

In case you hadn’t noticed, this past Saturday marked the 50th anniversary of US Surgeon General Luther Terry’s report, based on a three year study by “experts”, that definitively “proved” that cigarette smoking causes lung cancer.

The press conference was held on a Saturday back in 1964, out of concerns that the report would adversely affect the stock market. Think about that. Was Dr. Terry’s news revolutionary? Hardly. Studies since the early 50s had shown the same findings, putting a minor dent into cigarette consumption. A Reader’s Digest article from 1952 had had a similar effect. What’s interesting is that for a long time, public revelations of scientific “fact” about the nasty biology of smoking were always effectively countered by industry counteroffensives, most notably the “filter” scams that claimed to trap toxins – my Mom smoked “dual filter” Tareytons, which were advertised on the LA Dodgers’ radio broadcasts, though I don’t recall if they were the team’s official cigarette.

The industry also always had their own studies, of course, which suggested that any tobacco-cancer links were “inconclusive”, kind of like current “studies” that cast doubts on whether fossil fuels cause climate change. Since 1965 or so, the inexorable cultural march towards agreement that smoking is unhealthy has proceeded steadily, towards today’s general agreement that it is rather self- destructive, and is even inappropriate in outdoor public spaces. My Mom would always admit that it was “a dirty, filthy habit”, even as she continued to do it, but nowadays smokers and the rest of us cannot avoid the news that smoking is “the leading preventable cause of death in the US.” Kids learn this in the third grade, and some go home and start disposing of any trace of the evil stuff they find in the house, an action that never crossed my mind in the old days. You were lucky, Mom! Yet all this fact and logic and cultural disapproval still leaves us with over 43 million smokers, the 18%, for whom “preventable” doesn’t mean much.

What’s going on and what’s it going to take? It is a huge clinical challenge, as providers all know, a frustrating (and fascinating) aspect of our work here. My Mom quit cold turkey after 55 years when she moved to Canada, where the darn things cost four more bucks a pack. Not worth it! She’s 91 now, and has always claimed that “quitting was easy”, but in 20 years has never been able to explain why. If she ever can, I’ll let you in on the secret, though I have my theories. Maybe there will always be that 18%, who know we are always available whenever they wish to try quitting once again.

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