The demonization of smokers

I just finished my first year in medical school and my last 8 weeks were spent studying the effects of smoking on arteries in all its gruesome detail. Smoking undeniably causes grave damage to arteries and will kill many of us from heart attack and stroke before we even get a chance to get lung cancer. They must have shown a dozen ads from the series “Every cigarette is doing you damage“. They’re the best anti-smoking commercials I have ever seen. So why I am smoking a cigarette right now?

Technically, I quit more than a year ago, before I applied to medical school. I absolutely did not want to preach to patients what I did not practice. 95% of the time I am ferociously chewing nicotine gum to the annoyance of my husband and classmates. 5% of the time I am buying a pack of cigarettes – smoking a few – throwing the pack away – digging in the trash for the pack – sneaking one in the bathroom with a rug under the door, the window open and the incense burning – sneaking just off campus for a smoke after a lecture on the dangers of smoking and then washing my hands, powdering my face and chewing mint gum to hide the smell – smoking on the way to/from the train station and home – soaking the pack in water before throwing it away so the pack is ruined – digging in the trash in the hopes that one of the cigarettes wasn’t broken from the soak and can be dried – and finally throwing the dry $7 worth of cigarettes in the garbage, or giving up on the wet pack yielding anything but a rotten smell in the trash can.

The kids at medical school are young, clean-cut and fresh-faced. They talk about smokers like they are strange alien-beings who engage in self-mutilation for some perplexing reason. Some of them think smokers are poor, uneducated people. They call them of “low SES” (socioeconomic status). One guy even remarked that they are mainly depressed people. They just can’t figure out why people would do something so “wrong”.

Why? Addiction ladies and gentlemen. Not just dependence (psychological, behavioral and yes, definitely pharmacological) – but addiction, which is something very different and poorly understood. Whatever your drug, there are people who become dependent and can quit successfully, and there are people who become addicted who become serial quitters.

Why people start smoking is better answered by such things as “SES”.

But back to demonization…

I personally don’t think that the major “wrong” in smoking is in taking personal health risks. I do not subscribe to the view that suicide is “wrong”. It is a terrible pity that some of us commit suicide (and we should seek to help such people motivated to do so), but I do not regard it as “sinful”. Where it is wrong, is in its effects on our loved ones. Which leads me to the point…

To do wrong, is to do wrong to others.

When I harm myself, I inadvertently harm my loved ones, who suffer to see me sicken myself or kill myself (immediately or slowly). They are harmed emotionally, socially, and in many cases, financially by my sickness or death. But they are also harmed when I blow my smoke rings in their oxygen supply.

If someone does not choose to smoke, they should not have to inhale it. They should not have to smell it in their homes or in enclosed public spaces, or even just outside the train station as they leave the suffocation of an underground space for anticipated fresh air.

Ban us in your pubs, your airports, your restaurants. Ban us from smoking in our cars with children. Raise the taxes on cigarettes, and heck, tax transaturated fat-food products too.

Just don’t demonize us.

Fifty years ago about half of you were smoking too. The ones who were just dependent were able to quit, but those of us who became addicted are having a harder time. Most of you today never picked up the habit, so don’t demonize those who did for having a hard time kicking it. Protect yourselves by banning us from blowing smoke rings in your face, educate the next generation on the dangers of starting up, make it more expensive for us to get our ciggies, and more inconvenient for us to smoke them. But have a heart and a mind, and recognize that the worst way to inspire behavioral change is through demonization. We just close ranks in response.

The most important lesson I can take into practicing medicine is “don’t insult the patient”. I won’t be demonizing my patient who eats rotten food, smokes cigarettes, drinks booze and refuses to exercise. I will be trying to educate them – non-judgmentally – on the the consequences of their behavior. Most of all, I will be trying to inspire them to change their behavior, and at all times recognizing that every one of us in our way harms ourselves, and inadvertently, those around us.

We just don’t always see it. Let’s lose the self-righteousness and help each other see.