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Posted on 02/27/2002 6:32:46 PM PST by Max McGarrity

In a recent article that ran in a number of Nova Scotia newspapers titled, "N.S. gun shy over anti-smoking action," journalist Parker Donham took the provincial government to task for not taking more decisive action to reduce smoking in the province. His underlying assumption is that smoking is wholly bad for the health of Nova Scotians, and bad for the financial health of the province due to the extra costs incurred for treating preventable, smoking-induced diseases. These views are strongly endorsed by the Medical Society of Nova Scotia and the majority of the medical profession.

However, apart from the fact that the case against tobacco is not quite as pristine as this, I have reservations about the motivation of doctors in our no-holds-barred, anti-smoking stance.

If there is no doubt smoking is at least a major causative factor in a number of common and often fatal heart and lung conditions, there is also evidence to suggest smoking can be a prophylactic against Parkinson's disease, Alzheimer's and ulcerative colitis. Smoking is also stated to be beneficial in some cases of Tourette's syndrome and schizophrenia. In short, even in terms of its effect on the health, smoking seems to have redeeming features.

As for the financial health of the province, there seems to be little doubt that in the short term, smoking does increase provincial health-care costs. However, tobacco taxes are a major source of government funds and therefore help pay for the health services smokers use. Clearly, governments everywhere are well aware of this.

In the long term though, it is less clear that smokers cost society less than non-smokers, as was suggested by a study from Holland, which received air time a year or so ago on CBC radio. This study examined the hypothetical financial effects on the Dutch health systems, both in the short and long term, which would follow if the entire Dutch population stopped smoking. The results were surprising.

Soon after the hypothetical cessation of smoking there would be a decline in rates of smoking-induced diseases and therefore of smokers' use of health-care services. If smokers continue to smoke, their average life expectancy is 10 to 15 years shorter than that of non-smokers, therefore considerably fewer smokers reach old age. But if smokers stop smoking, their life expectancy increases.

But the older we get the more we tend to cost society, irrespective of whether we smoke or not. After about 15 years the costs of maintaining this increased proportion of the elderly would exceed those saved by the decline in the occurrence of smoking-induced disease.

I might add—though I don't think this was mentioned in the report of this study—that some of the higher costs of caring for the elderly are related to the increased incidence and the chronic deteriorating course of such illnesses as Alzheimer's and Parkinson's—for both of which smoking may be partially prophylactic. It may then be possible that older smokers cost the system less than older non-smokers.

It is worth noting that there seems to be a distinct difference between the attitudes of physicians toward the use of alcohol and tobacco. Though physicians and others have paid considerable attention to the role of alcohol in road accidents and to other forms of violence, both private and public, doctors have paid much less public attention to the ill effects of drinking alcohol on physical health. These can include damage to the brain, the heart, the liver and the increased occurrence of cancers of the upper gastro-intestinal tract. I do not doubt that if we added up the combined health and social ill effects of alcohol use compared to that of tobacco, the justification for a campaign against alcohol would be every bit as strong, since the social ill effects of alcohol use are far greater than those of tobacco.

Yet I have not heard my fellow physicians fulminate against drinking. Nor have I noticed any attempt by physicians or our organizations to mount a campaign against alcohol or to have containers of alcohol labelled with the type of dire warnings found on every packet of cigarettes.

Neither have I heard of physicians or our organizations say much about the deleterious effects of exhaust fumes on health, nor have I noted any trend on our part to use more fuel-efficient, less polluting vehicles, nor to reduce our consumption of gasoline in other ways, yet there is much solid evidence to suggest exhaust fumes are not only deleterious for the health of the individual Canadian but for the health of most forms of life on the planet.

I might add that I have not even mentioned the carnage of man, woman, child and wildlife that occurs daily on our roads. More U.S. citizens die on their roads in a single year than died in the whole Vietnam war. On the contrary, my impression is most doctors own not one but two or even three cars and I doubt if fuel consumption is a primary factor in our choice of vehicle.

To make my own position clear, though I did smoke at one time, I am now a non-smoker. I do like a drink or two or three at times, I own a car and am over 65.

In my opinion it is no coincidence that a large majority of physicians are non-smokers, while probably an equally large majority are drinkers—even if mostly in moderation. Many of us like our good wines and expensive single malts. We also love our gas-guzzling SUVs. It is therefore easy and painless for most of us to campaign against tobacco since our comfortable lives would be little affected even if smoking was completely banned. On the other hand this would not be the case if more severe restrictions were imposed on drinking alcohol (certainly I wouldn't like it) or effective measures taken to force us to limit the number and/or the use of our vehicles.

Though it may not be flattering to our self-image to say so, I believe it is for these rather superficial self-serving reasons that doctors will continue to campaign against smoking while, at the same time, it is highly unlikely we will ever see similar physician-driven campaigns against either alcohol or gasoline.

James O'Brien is a psychiatrist in private practice in the Baddeck area of Cape Breton.  

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