Tobacco - the enemy within..

Let me start with a story…

There was once a village where the local people faced a grave problem. Every morning – exhausted and weary villagers were to be found drowning in the fast flowing river that ran through their village. The local community set up an elaborate and expensive alert and rescue system which enabled every drowning man and woman to be dragged out of the water, resuscitated and saved.

For years the village community struggled on, but they were poor because all their resources went into the daily lifesaving process. Then one day, a wandering minstrel happened by, and suggested that rather than saving the villagers – wouldn’t it be a good idea to find out why they were in the river in the first place?

I could continue the story with giants, goodies and baddies and elaborate plots but suffice to say, as soon as the locals realised what was causing their comrades to be in the water in the first place, they fixed it and the rescue and repair system was no longer needed.

My recollection of this well-known fable was prompted by a startling report published in the British Journal of Cancer announcing that 40% yes – 40% of cancers diagnosed in the UK each year are caused by avoidable life choices such as smoking, unhealthy eating and excess alcohol. Tobacco continues to be the most significant cause, accounting for a risk factor of 23% in men and 15% in women. I would like to optimistically assume that these figures would drop as public knowledge and understanding increases but there are no indications that this will be the case.

At a time when we are desperately seeking not only cures for cancer but also trying to reconfigure our health services to ensure that we can afford to treat an increasingly unhealthy population surely we should be doing more to stop people developing illnesses in in the first place?

The smoking debate is long running and emotive. There have been accusations of ‘nanny state’, ‘destroying human rights’, ‘restricting personal choice’ and the  pro-smoking lobby even disputes the extent of the dangers of tobacco. In medicine there is a measure known as the Therapeutic Index – which is the ratio between the toxic dose of a drug and the therapeutic dose (i.e. a dose that works). This is a useful measure of the safety of a drug and if the therapeutic dose is the same as the toxic dose then it is likely this drug will never get a licence. Even the rarest of side effects may stop the development of a drug in some cases and yet a massively toxic substance is freely available, with only an age regulation associated with it’s distribution and consumption.

In the UK you can be fined for not wearing a safety belt and even imprisoned for holding your mobile phone while driving (quite rightly). Children are no longer allowed to play with conkers in school without safety goggles. The same children at just 16 years of age can smoke a small piece of paper wrapped around a lethal substance responsible for 100,000 deaths annually and possibly twice as many people suffering life limiting disease. As soon as they are 18, they can buy this lethal substance in packs of 10 or 20 throughout the UK. Even that piece of legislation is crazy – you can smoke at 16 but can’t buy cigarettes until you are 18. I’m sure that makes a big difference to teenage smokers – not.

How can this madness be stopped or at least reduced? Yes, if the substance was banned it would drive smoking underground but surely the number of smokers would reduce dramatically. Yes tobacco -growing economies would be severely damaged but surely alternative crops could be grown? Yes, the UK government would in the short term lose significant taxation income and face huge pressure from the powerful tobacco companies’ lobby but in the long term, healthcare costs from smoking-related diseases would be massively reduced.

At a time when the Health and Social Care Bill is concentrating on the minutiae of who commissions what, disbanding and reconfiguring the beaurocratic process we continue to allocate massive resources on fishing the villagers out of the river. I can’t help but wish more time and resource was spent on stopping them jumping into the water in the first place.