The tobacco industry may have been sued by the states for more than $2 billion in 1998, but it still has a lot going for it. The tobacco companies continue to operate globally raking in gobs of money. They also are still attracting multitudes of new smokers even as scientists continue to discover new disorders caused by the tobacco, including cataracts, liver and kidney cancers. The big tobacco companies are also opening up new markets for their addictive products in the developing world. So what can the tobacco control forces hope to accomplish against this juggernaut of human misery, which is projected to cause one billion deaths over the next 100 years? Quite a lot, actually, said Jonathan Samet, MD, MS, at the World No-Tobacco Day conference held at the Johns Hopkins Kimmel Comprehensive Cancer Center on May 31. Samet, addressing what health professionals can do to fight tobacco, said, “We need to be leaders, need to be involved; and we need to watch out for this industry.” Tobacco, he said, is not “just” a cause of death but a cause of early death. “Every clinician has come face to face with the 30- to 40-year-old patient with incurable lung cancer, who started smoking at age 10.” Samet said much progress has been made. Most hospitals have now banned smoking and the number of physicians who have quit has increased greatly. Samet, professor and chair of Epidemiology at the Bloomberg School and director of the Institute for Global Tobacco Control, can still remember how, 30 years ago when he was starting out, the rooms where doctors and nurses worked on patient charts were as smoky as the seediest bar and grill. He also told how, as a young clinician-scientist, he once gave a grand rounds presentation on helping patients stop smoking, and was told by the chair of his department, “Oh, I tried talking to my patients but it didn’t work, so I stopped.” Now we know how to help patients to stop. Samet emphasized that patients do listen to their health providers. “We can give them that additional little nudge” to become successful quitters, he said. And, he reminded the audience, physicians now have a whole new pharmaceutical armamentarium of their own, with which to fight the addictive power of tobacco. Samet said physicians must also keep in mind that the facts are on their side: “Today, physicians can say with confidence that smokers aren’t only harming themselves but also the health of their families.” Samet doesn’t underestimate his foe, however, and said, “We’ve got a lot of work to do on training our health professionals,” pointing out that most physicians and medical students are still not getting enough formal training in tobacco control. Last, Samet cited the Framework Convention on Tobacco Control (FCTC), a treaty that is still being ratified by some key countries but that is expected to spearhead a global strategy to fight a global menace.--Rod Graham
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