My
truth is a tale of smoke and cynicism, power and death, and a glimmer
of fiery, fragile hope.
I
tripped
up
the
stairs,
clutching
a
clipboard
and
breathlessly
reciting
the
signs
of
chronic
obstructive
pulmonary
disease
(COPD)-
tar
staining,
cyanosis,
hyperinflated
chest,
wheeze.
Suddenly
my
train
of
thought
was
derailed.
There
was
a
cigarette
butt
wilfully
loitering
on
the
steps.
Even
here.
I
felt
a
stinging
slap
of
hopelessness-
my
little
nicotine
nemesis
was
so
beloved
that
it
was
able
to
sit
bold
as
brass
on
the
steps
to
our
respiratory
ward.
I
gave
it
a
vicious
look,
trudged
onwards
and
started
a
new
list.
Bed
4,
end
stage
COPD-
clutching
a
Venturi
mask
to
her
face,
every
inch
of
her
body
exhausted
by
the
effort
of
gas
exchange,
breathing
as
hard
as
a
marathon
runner,
knowing
it
wouldn't
stop
until
she
died.
Bed
7,
query
lung
cancer-
his
awake
bronchoalveolar
lavage
the
single
most
horrific
procedure
I'd
ever
seen.
A
sort
of
iatrogenic
water
boarding
that
had
failed
to
provide
any
information
on
the
large
mass
dominating
his
chest
X-ray.
My
list,
and
most
of
the
people
on
our
ward,
were
testimony
to
the
power
and
horror
of
tobacco.
The
tendrils
of
tobacco's
power
reached
beyond
the
respiratory
ward.
I
could
take
a
history
anywhere
in
any
hospital
and
when
someone
described
themselves
as
a
smoker,
my
heart
would
sink
a
little
at
their
increased
risk
of
heart
disease,
hypertension,
stroke
and
cancer.
As
a
medical
student
my
inner
optimist
would
enquire
about
smoking
cessation,
but
the
barrage
of
polite
declines
slowly
eroded
this
optimism
and
by
the
time
I
was
qualified
the
question
was
almost
a
formality.
Sadly,
my
blossoming
cynicism
followed
me
out
of
the
hospital
and
all
the
way
home.
One
of
my
friends
was
a
smoker
and
philosopher
who
somersaulted
his
way
through
arguments.
We
debated
life,
the
universe
and
smoking.
As
a
scientist
I
would
hurl
statistics
at
him-
100,000
people
die
every
year
in
the
UK
from
smoking
related
illnesses.
8
in
10
non-smokers
live
beyond
age
70,
but
only
half
of
long
term
smokers
do
(1).
I'd
outline
the
dangers
of
second
hand
smoke
and
give
graphic
descriptions
of
how
people
suffocate
over
weeks
and
months
thanks
to
emphysema.
Nothing
phased
him.
He
knew
the
risks,
it
was
his
choice.
He
felt
my
desire
to
dissuade
him
bordered
on
the
unethical
because
it
insulted
his
autonomy.
The
reality
was
I
had
no
real
ability
to
change
it.
And
perhaps
I
was
being
a
dictator
to
even
try.
Certainly
my
friend
wasn't
alone,
British
society
accepted
smoking,
what
right
did
I
have
to
disagree?
People
have
free
will,
let
them
exercise
it.
Then
two events shifted my perspective: the death of a loved one and a
political triumph.
Coffins
are small. They house a body, but they can never hold a person. My
cousin baked the most amazing biscuits I'll ever eat, she loved music
and had unending patience for jigsaws. She was kind and generous and
irreplaceable. These things, the things that made her who she was,
live in my heart and in every person who was lucky enough to know
her. She died in her forties from lung cancer.
34,859
families
stood
over
coffins
because
of
lung
cancer
in
2010
(2).
Being
one
of
those
families
has
completely
dissolved
any
qualms
I
had
about
impinging
on
people's
ability
to
smoke.
My
philosopher
friend
may
want
his
autonomy,
but
on
balance
I
think
the
world
would
be
a
better
place
with
fewer
cigarettes
and
fewer
coffins.
Sod
your
right
to
inhale
tar
and
cyanide
and
die
gasping.
I
realise
my
opinions
may
offend,
so
let
us
turn
to
a
safer
subject:
politics.
I
come
from
Scotland,
a
wild
country
that
is
famed
for
its
whisky
and
which
offers
a
plethora
of
pubs
to
drink
it
in.
I
never
hoped
we
would
be
able
to
ban
smoking
in
these
pubs,
yet
in
March
2006
Scotland
did
exactly
that
with
a
ban
on
smoking
in
enclosed
public
places
(3).
In
2007
Wales,
Northern
Ireland
and
England
followed.
The
positive
impact
on
health
has
been
notable-
air
quality
in
pubs
has
improved,
bar
workers
have
better
respiratory
health
and
hospital
admissions
for
acute
coronary
syndrome
are
down
(4).
Whilst
I
expected
improvements
in
health,
I
didn't
expect
it
to
be
popular.
A
recent
survey
of
12,000
British
adults
found
that
78%
supported
the
ban
(5)
.This
societal
support
and
the
political
will
to
ban
smoking,
stirred
my
comatose
optimist
and
gave
me
a
glimmer
of
hope.
This
year, my optimist was brought back fighting by the Australian
government. 2012 was the year that Australia passed a plain packaging
law to standardise cigarette packets (6). Goodbye camels and cowboys,
hello disease addled eyes and cancer ridden lungs on a murky green
background. Lest we forget who is responsible for selling these
deadly wares, companies can put their name on the packet in a dull,
diminutive font. It has been said this will have no impact on
smoking, but the tobacco companies' reactions tell a different story.
British American Tobacco, Imperial Tobacco, Philip Morris and Japan
Tobacco all took legal action against the Australian government,
claiming the law violated the companies' intellectual property
rights. Philip Morris also asserted the law would contravene a
bilateral trade agreement with Hong Kong that would leave the
government liable to pay Philip Morris huge amounts in compensation
(7). Thankfully the Australian High Court ruled that the laws were
sound and they will come into force in December 2012. The perfect
Christmas present for Australian hearts and lungs.
With
the
return
of
my
fiery,
fragile
hope,
I've
come
to
find
my
truth.
Trying
to
stop
people
smoking
wasn't
thinking
too
big,
it
wasn't
thinking
big
enough.
We
can't
take
on
tobacco
one
smoker
at
a
time,
it's
like
trying
to
stop
malaria
by
catching
every
mosquito
in
the
world
with
a
pair
of
chopsticks.
We
need
to
be
murderously
ambitious.
We
need
to
suffocate
the
tobacco
industry.
The
World
Health
Organisation
(WHO)
have
defined
the
elimination
of
leprosy
as
a
prevalence
of
less
than
1
case
per
10,000
of
the
population
(8).
Using
this
definition,
I
believe
it's
realistic
to
eliminate
tobacco
smoking
in
the
UK
in
my
lifetime.
Given
longer
I
think
we
can
eliminate
it
worldwide.
You
may
say
I'm
a
dreamer,
but
if
you
look
at
the
statistics
of
smoking
we
really
have
no
choice
but
to
make
it
happen.
In
the
Lancet
earlier
this
year,
Giovino
et
al
reported
the
results
of
the
Global
Adult
Tobacco
Survey
of
14
low
and
middle
income
countries.
40.7%
of
men
in
the
survey
smoked
a
tobacco
product,
ranging
from
21.6%
in
Brazil
to
60.2%
in
Russia
(9).
These
high
demand
rates
are
readily
met
by
the
tobacco
industry
with
cigarettes
being
manufactured
faster
and
cheaper
than
ever
before.
One
of
the
most
formidable
accounts
of
this
mass
production
of
death
was
penned
by
Proctor
this
year
(10).
He
uses
the
assumption
that
one
death
is
caused
by
every
million
cigarettes
smoked,
to
provide
some
sickening
statistics.
“…the
6
trillion
smoked
in
1990
will
cause
about
6
million
deaths
in
2015.
That's
one
death
every
5 seconds.”
“Cigarette
companies
make
about
a
penny
in
profit
for
every
cigarette
sold...a
tobacco
manufacturer
will
make
about
US$10 000
for
every
death
caused
by
their
products.”
We
can even make our own relatable statistics. Philip Morris' Richmond
plant in Virginia, USA made 146 billion cigarettes in 2010. That's
146,000 deaths. The Kunming Cigarette Factory in China made just 71
billion that year, a paltry 71,000 deaths (10). Between these two
factories, in a single year's production they will kill the
equivalent of every man woman and child in the town I was born in. 54
times over. Don't feel left out, its a game we can all play.
Hopefully
you're
now
asking
yourself
“how
do
we
end
it”?
Some
suggestions
are
well
known,
such
as
plain
packaging,
high
taxes,
restricted
advertising
and
accessible
cessation.
But
ours
is
an
ambitious
aim,
which
will
require
daring
and
innovation.
Borland
(11)
has
proposed
a
regulated
market
model,
which
would
take
mass
marketing
away
from
the
tobacco
companies
and
hand
it
to
an
agency
with
a
harm
reduction
charter.
Advantages
of
this
approach
would
include
brand
control,
price
control
and
the
ability
to
incentivise
manufacturers
reducing
the
harmfulness
of
the
products.
An
equally
bold
idea
is
Daynard's
suggestion
that
reducing
nicotine
levels
in
cigarettes
to
non-addictive
levels
could
secure
a
smoke
free
future
(12).
While
I
think
both
of
these
ideas
are
compelling,
I
also
find
a
certain
radical
appeal
to
Tasmania's
“2000
Smoke
Free
Generation”
idea,
which
would
ban
the
sale
of
cigarettes
to
anyone
born
after
the
year
2000
(13).
All
of
these
ideas
are
big
and
brave
and
massively
problematic,
much
like
taking
on
the
tobacco
industry.
Together,
the
biggest
tobacco
firms
make
more
than
$1,100
of
profit
a
second
(14),
so
they
have
much
to
lose
if
smoking
declines.
This
fact
was
felt
by
the
Australian
health
department
when
they
were
passing
the
plain
packaging
bill
through
parliament.
The
team
were
“swamped”
by
63
freedom
of
information
requests,
52
of
which
were
courtesy
of
tobacco
companies
in
what
has
been
described
by
commentators
as
“a
specific
and
deliberate
attempt
to
divert
resources”
(15).
Disappointingly,
tobacco companies
are
being
aided
in their efforts to maintain power and profit
by
the
policies
of
some
countries.
The
WHO
Framework
Convention
on
Tobacco
Control
came
into
force
in
2005
and
was
a
landmark
achievement
in
international
public
health.
It
sets
minimum
standards
for
tobacco
control
which
are
legally
binding
in
176
countries,
covering
every
aspect
of
the
industry
from
production
to
marketing
and
taxation.
Yet,
even
under
a
Democratic
President
with
a
vocal
commitment
to
healthcare
the
United
States
has
not
ratified
the
convention
(16).
Clearly
there
is
a
long
way
to
go
before
my
hopes
are
realised.
The
tobacco industry has the audacity to make millions of dollars selling
an addictive product which causes millions of deaths. We must be as
smart, as ambitious, as bold as they are. If ever there was a man who
captured all of these qualities it was Apple's visionary leader Steve
Jobs. In 2005 at Stanford University he delivered the most moving and
inspiring piece of public speaking I've ever heard. His advice was to
“Stay hungry. Stay foolish.” This is the mantra public health
needs- from smoking to obesity, from malaria to HIV, it is imperative
we think big. When devising solutions we shouldn't just accept our
limitations, instead we must push them, shove them, shatter them.
Stay hungry. Stay foolish. That's my truth, now tell me yours.
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