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Smoking

It matters little what you think of smoking as a lifestyle choice if you are a smoker. If you are a non-smoker, your opinions hold only limited sway among your smoking counterparts. For smoking, if you will, clouds the mind of the smoker to such a degree that he is unable to fully comprehend what he partakes of with each inhalation.

A far-reaching premise, I'll admit, but not without some merit. In all seriousness, the smoker is rarely consumed to such a degree by his habit that he's rendered "dazed and confused." More potent drugs offer up this scenario much more readily. But do not think that negates the point: smoking is both physically and psychologically addicting and if as much emphasis had been placed on the latter form of addiction, the battle lines in the smoking wars might have been more clearly drawn.

No physician need be reminded of the physical damage extolled by smoking. No healthcare provider need reveal what it's cost to providers. No lawyer needs to be told how much it has cost the states in lost income. No manager need be reminded of how many man hours are lost to smoking related illness. The tobacco companies were defenseless when presented with evidence procured from their own research files certifying nicotine's addictive nature.

Indeed, the citizens themselves are not blind to the adverse effects of smoking, at least here in the United States where public health policies employ a wide range of deterrents and precautions that make most underdeveloped nations look like relative healthcare anarchies.

Still, tobacco companies rake in huge profits. Millions of adults smoke and millions of children start every year. Even among those who've suffered severely from the adverse effects of nicotine and tar, many find it beyond their capacity to quit. Some individuals with smoking related illness smoke until their last dying breath.

Public health officials recognize a vast array of smoking patterns based largely on personality type, physical predisposition and relative awareness of the activity itself. Some individuals are avowed smokers, staunchly unwilling to give up the habit because they derive such pleasure from it. These individuals may or may not be aware of or care about the adverse effects. If they are aware, they may care, but remain nonetheless willing to take their chances. Or, they may be aware and moderately fearful of adverse effects, but make the choice to continue, albeit with reservations. Others may be unaware completely, though finding an individual in this country who is completely ignorant of smoking's costs to the body is increasingly rare.

Other smokers are reluctant smokers, caught up by a practice they enjoy, but seeking freedom from its addictive consequences. They want to quit, they try to quit, but they simply cannot break the habit. It is, incidentally, a sad use of euphemism to refer to smoking as a habit when one really refers to an addiction. Not all people who smoke are in the habit of smoking. Some do so with such infrequency that they are referred to as casual smokers. Not all habitual smokers are addicted. Some people can stop smoking at will, only to resume the habit when they choose to. Then there are the individuals who are quite seriously addicted to nicotine and cannot quit without some form of chemical assistance. What may have begun as casual turns to a casualty -what was perceived at first as an experiment became a habit and transformed into the incipient stages of what later would become a full- fledged addiction.

People forn habits and addictions to varying degrees based on many factors. Some people grow into and out of habits. Some individuals have more addictive personalities by nature than others. Given the ample diversity of reactions to this one particular public health menace, physicians and public health officials cannot rely on a silver bullet solution. It is doubtful that smoking will ever be fully under control in this country, largely due to two factors.

Firstly, though tobacco companies have clearly been caught with the proverbial smoking gun, the legal leverage that their financial muscle can exert among lawmakers, as well as in the realm of advertising, is enormous. Though measures in this country have hit them hard, such as the ongoing statewide class action suits and the recent ban on billboard ads, there remain a multitude of legal ways, however insidious, they can continue to draw people into that first smoke. Further, the prospects for some form of legal prohibition, will most certainly be fought on the grounds of civil liberties and will suffer the same fate as the prohibition of alcohol.

Implementation aside, prohibition would be inadvisable from a rational standpoint. It has done little to discourage the use of other drugs and enforcement costs would be astronomical. Besides, in a democracy, citizens should be encouraged to make choices based on their knowledge of issues, as presented to them by the press, government bodies and as obtained by them through their own individual efforts.

Which implies the second hurdle and suggests some manner of recourse. For like lemmings at the cliffside, each new generation must undergo the various rites of passage that our culture has adopted, one of which is taking that first smoke. For the unlucky few who have a predisposition towards addiction, it only takes one or two puffs before they're onto increasing use of tobacco. And the use of tobacco is the abuse of tobacco-or better yet, the use of tobacco amounts to the abuse of the user. Howsoever we may try to dissuade young people from taking up smoking, the arrogance of youth will always prevail because "you gotta try everything once" has a convincing ring to it.

I, for one, might be considered a great adherent of that particular philosophy when it comes to matters less dangerous. Experimentation is a good thing, but I wouldn't play Russian roulette for the experience, however genuine or authentic it might feel. The risk/reward equation simply doesn't add up. But even this is a subjective choice, as is smoking. Initially, we must realize that trying that first cigarette is a subjective choice, howsoever that choice may be influenced by advertising, peer pres- sure, experimental curiosity, etc.

What we as a society must do is emphasize the objective risks as early as possible to counter-weigh the massive influence of these pro-smoking forces. That is the true responsibility of the public health sector. To fight the tobacco companies' propaganda with a campaign of objective truth. To utilize their offensive tactics in our defense. To allay the forces of science, reason and wisdom against those of pseudoscience, dependence and ignorance.

An educated citizenry is a better citizenry and a healthier citizenry, but our system of government does not guarantee its citizenry education or defense against subtle forms of influence that our economic system clearly depends and thrives on. It does, however, guarantee them the freedom of speech. And the voices speaking out against smoking need to more concerted, vigorous and, yes, shameless. No longer should the warning label on cigarette packs be typed in fine print. It's utter hypocrisy, and reflects how much legislators have caved in to the tobacco lobby.

Ultimately, however, the fight will be for a generation not our own. If we can reduce the number of early users, we can reduce the rate of ensuing casual, habitual or addictive users of tobacco. It's a question of stopping the harvest of young smokers-and the odious harvest of tobacco-at its very roots.

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