Meditations of Lambchop

A little thought experiment

Imagine that you could buy suicide bags  (as the name implies these are bags used to commit suicide) at your local supermarket and that in fact you are the owner of one such supermarket. You see that a lot of kids from the neighbourhood are buying these bags. As a good citizen you are naturally concerned, and so you ask one of the kids, one who had bought a bag just the previous day, “are you trying to kill yourself?” “No,” he replies, “we just like the feeling.” He also informs you that, actually, the bags are not that effective – they only kill some of the time, and sometimes you have to use more than one. You continue enquiring and find that, in fact, some kids have died, mostly ones who kept using the bags over and over. “Did they want to die?” you ask. “No, no, of course not. They just couldn’t stop, the kid answers nonchalantly.”

If you continue to sell these suicide bags are you a murderer? You are selling a product that is likely to kill to people who don’t want to die, but are either (a) under social pressure to use it, (b) enticed by danger or rebelliousness of using it or (c) are addicted to the effects. If you are one of the kids who use these suicide bags and encourage or even just allow others around you to use it, are you a murderer?

Or should we invent a new word for taking people’s lives in a way so subtle that society can’t fully condemn it?

I am not talking about drugs. Drugs are far too clear cut. I am talking about cigarettes. One of my statistics professors once related a saying in her field of health statistics: if you want to find a statistically significant result, then just compare smokers and non-smokers. The evidence for how bad smoking is (hubbly bubbly is just as bad, if not worse) that overwhelming. In today’s post: why cigarettes are murder weapons, why the evidence doesn’t matter, and an appeal to doctors who smoke.  (Yes, some doctors do smoke. This seems amazing, until you think about it.). I don’t know how to stop people from smoking. I don’t know how to make it uncool. But I still want to rant about it, even though I know that my following paragraphs will no effect on anyone’s behaviour.

Facts

Let me first state some obvious facts:

•  There are companies out there that legally sell a product that (slowly) kills people: the owners,  managers and employees of tobacco companies are (paid) murderers.
• If you smoke you are not only (slowly) killing yourself, as is your right, you are legitimizing the existence of a company that kills you and countless others – you are paying for murder.
• If you smoke you are setting an example – that it is ok to use a product that slowly kills you and that it is ok for such a product to be sold. You are giving permission for murder.

The above facts are not negotiable (except, perhaps, for the definition of “murder”). But they don’t matter. I’ve never met a smoker who thinks smoking is good for them, or even just not harmful (in fact smokers even overestimate how bad smoking is for them). People don’t start smoking because they underestimate the dangers of it. They start because they are emulating their peers, people whose respect and notice they want, that they need. They don’t stop because they become dependent, and so they continue smoking long after the need for social acceptance is gone.

It does not matter how much you tell people how bad smoking is for them – this will not prevent them from starting and it will not (barring a handful of cases) get them to stop. I suspect (but I cannot prove) that those smokers who stop smoking do so for social acceptance too – there are people in their life whose respect, admiration, friendship, love they want and they will stop smoking to get it. Alternatively, they want to fit into a society that stigmatizes their habit (which, is perhaps more likely to be the experience when you exit your teens and twenties).

Stop for others (especially if you’re a doctor)

If you smoke, even occasionally, consider the harm you are doing to others. You are harming them through your second hand smoke, by supporting the smoking industry and by giving others permission through your example. Is it not your moral duty to stop? Is it not your moral duty to proclaim that you regret your first cigarette? (You must do both: to stop without regret is to fool others into thinking the habit is easy to kick and to say you regret smoking without stopping is meaningless because people respond to actions, not words).

If you are a doctor who smokes, you have a far greater responsibility. What does “do no harm mean” if you support murder and addiction? How can you tell a patient to stop smoking, for their health, if you have not done the same? Why should they listen? People might be astounded to think that doctors, or medical students, can smoke. But smoking is not about the facts, the statistics, or morality. It is all about social acceptance and, later, addiction.

I think it must in some ways be so much harder for a doctor to stop, merely because of the highly stressful environment doctors often find themselves in. (Nicotine does relieve tension, but when you’re addicted, you need the nicotine just to get back to a “normal” level.) I want to ask you please to stop anyway, not for yourself, but for your patients. Because people can smell hypocrisy. If you tell a patient to stop smoking or counsel a room full of children about the dangers of smoking, you must be able to speak of cigarettes with an absolute revulsion and the conviction that can only come from having stopped smoking completely. Anything less and you are not honouring the code of your profession.