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What cigarette do you smoke, doctor?

i-e7a12c3d2598161273c9ed31d61fe694-ClassicInsolence.jpgI’ve pivoted immediately from attending NECSS and participating in a panel on the infiltration of quackery into academia to heading down to Washington, DC for the AACR meeting. Then, after a packed day of meetings yesterday followed by spending yesterday evening with a friend whom I haven’t seen for a long time, there’s–gasp!–no new material today. Fortunately, there is this amusing little thing from two and a half years ago (which means it’s new to you if you haven’t been reading that long). It’s also very appropriate, given that I’m at a big cancer research meeting and the decreasing number of smokers over the last several decades has done more to reduce death from cancer than just about anything else. Speaking of cancer and cancer research, if any of you are here in DC at AACR, drop me an e-mail. Maybe be can meet up. See you tomorrow right here, same Bat time, same Bat channel.

These days, pretty much everyone, smokers included, knows that smoking is bad for you. It promotes lung cancer (and several other varieties of cancer as well), heart disease, emphysema, and a number of other health problems. If you ask most smokers, they will tell you that they’d like to quit but have found it very difficult. Indeed, we are now starting to appreciate that secondhand smoke is a health hazard, leading some states and localities to ban smoking in public spaces.

This is a huge change in the 43 years since the original Surgeon General’s report on the danger of smoking was released. At that time, 46% of all adult Americans smoked (including 50% of men), and smoking was accepted in elevators, airplanes, offices, restaurants–in other words, almost anywhere and everywhere. These days, only around 25% of Americans smoke, which is still enough to result in lots of smoking-related disease and death, but smoking is definitely nowhere near as socially acceptable. If you really want to get an idea, though, of just how accepted smoking was, looking at some old commercials is just the ticket to show it. For example, take a gander at this ad campaign from 1952, in which it is asked: What cigarette do you smoke, Doctor?


Note the doctor smoking right in his office. One wonders if he walks into exam rooms with a cig hanging out of the side of his mouth. In any case, it’s amazing to me how cigarette companies tried to link smoking with health by emphasizing doctors’ recommendations for cigarette brands–as if doctors’ habits are any more healthy than anyone else’s or as if doctors couldn’t be bought off with tobacco money.

This next commercial takes it a step farther (note that there are two commercials in this clip and the second one has nothing to do with smoking):

The “study” described in this ad is ludicrous in the extreme. It would be hilarious if it weren’t so deceptive. For example, there’s no control group; it’s not in any way blinded (smokers or physicians doing the examinations); it mixes new and longtime smokers; and it only follows them for six months.

Finally, if you want an indication of just how much things have changed, these next three ads associate associate smoking with either glamor:

Or romance:

Because nothing says romance like a mouth full of tobacco smoke remnants.

Or athleticism:

Smokers who know smoke the big O? I could come up with lots of cracks about that one, but I’ll refrain for now.

In fact, smoking was so accepted that cartoon characters were not infrequently used to advertise them:

Fred, Barney, how could you? In actuality, how could they not? Smoking was totally accepted back then; so why shouldn’t cartoons be used to advertise cigarettes? [2010 update: Amusingly, a question on Jeopardy the other day asked what was edited from Tom and Jerry cartoons for video. The answer, of course, was showing Tom and Jerry lighting up.]

Perhaps my favorite ad, although it doesn’t really have anything to do with trying to convince you that cigarettes are healthy (or at least not unhealthy) or associated with romance or athleticism, is this 1948 Lucky Strikes ad:

“So round, so firm, so fully packed”? I’ll leave it to the reader to interpret that one.

Yes, it’s a totally different world now than it was 50 years ago, at least when it comes to smoking. And that’s definitely a good thing.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

42 replies on “What cigarette do you smoke, doctor?”

… I kinda want the toy advertised in that second commercial in the second clip.

What a weird world we lived in back then, people legitimizing a harmful practice by performing bogus studies and claiming that only the crazies believed otherwise… oh wait.

You know what bugs me almost more than any doctor smoking (or most doctors smoking in the 50’s along with everyone else) is that Nurses – many many many nurses smoke. They know smoking is bad for you, and bad for everyone. But Nurses have very stressful demanding jobs, they are underpaid and overworked (tons of mandatory overtime) and the only way they can get a break where they won’t be bothered for two minutes? Cigarette break.

I know this growing up as the child of a Registered Nurse; my mom has smoked my whole life. I also didn’t see a lot of her growing up, due to the long long work hours she put in at the various hospitals, nursing homes, even state run facilities where she worked. Nurses are amazing people, dedicated to those in their care and the most visible people in most medical settings. You spend much more time during the course of your life being taken care of my Nurses and other trained health workers than you ever will with a doctor. And then too they are visible, though not as much now with laws about how close to healthcare facilities they can stand, while smoking trying to have a few minutes of calm and quiet.

I would visit my mother at work on the way home from school, when she took her break with any number of other nurses, on the back patio- smoking. Of the staff of that particular clinic, devoted to kidney dialysis patients, I can recall two of the nurses on staff out of perhaps 30 that were not smokers. I never got to know them, they were never on break.

These people know the facts about the ridiculously harmful effects of smoking, as most of us do about the various things we do to our bodies or the substances we consume that are bad for us, dangerous or even illegal. In this case, just like most things in life this is a personal choice that despite the evidence they choose to make as they live their lives. Sadly, it will likely be a shorter life.

One of my all-time favorite ads for the dangers of smoking was a billboard I used to drive by all the time. Taking its cue from the old “Marlboro Man” ads, it showed two cowboys riding off into the sunset. One says to the other: “I miss my lung, Bob…”

While it’s easy to pretend that human behavior should always respect known risks, it’s also easy to forget that smoking conveys a highly addictive drug. Yes, I smoke. Yes, I wish I had the will, or the fortitude, or the spine, or the physiological ability, to quit. Of course I wish I’d never started. No, I don’t blame anyone but me. All that whined? Yes, I smoke.

If it were a matter of pure intellect, smoking would just be an unkind form of natural selection. Sadly, no.

Enjoy DC, Orac. I’d offer to get downtown to meet, but too many people think too many other things are important today. Have a safe and enjoyable stay, and learn things.

My favorite line: ‘Salem is softened with fresh air’.

Orac, you are less than 100 miles from me. I really wish I had the time to go up there and meet you. I doubt I would be terribly interesting to you, but I would love to have a few minutes to talk to you. Hope you have a good trip, D.C. is beautiful this time of year.

While it’s easy to pretend that human behavior should always respect known risks, it’s also easy to forget that smoking conveys a highly addictive drug.

Smoking addiction goes well beyond the effects of nicotine. If it didn’t, nicotine patches would be a lot more than 7% successful at stopping smoking.

I contend that smoking is an addictive behavior. It’s like how gambling can be an addiction, despite no chemical dependence. It’s an addictive behavior like cracking your knuckles, or biting your fingernails.

It’s just a lot more expensive and dangerous to your health than cracking your knuckles.

My father always told the story from his med school time in the 50’s; the senior full professor of surgery repeatedly set things on fire in the operating theater due to the combination of ether used for anesthesia and smoking.

@ Swoopy

I appreciate your devotion to your hard-working and dedicated Mom as well as your humanity and tolerance. Just would like to mention that when I once had a very stressful job and wasn’t getting any breaks, I decided to go out back with the smokers twice a day just to get away. You don’t have to smoke to join this lot and if the area is open, hopefully you don’t get much second hand smoke or be sickened by that horrible smell. I never lectured the smokers or even commented on their “habit”, but when one of them came down with breast cancer (she had smoked for many years and claimed she could not quit) she did manage to quit for a couple of months. We were all shocked when she then took it up again. This was about 20 years ago and I believe she is still alive and in late middle age. Go figure.

The movie that really drove home the difference in smoking attitudes was when I saw All the President’s Men in the mid eighties on cable TV. By then, most professional offices were smoke free, and when I saw all the reporters lighting up at their desks, I was really taken aback. And then I remembered, “oh, yeah, that’s how it was, only 10-15 years ago.”

My dad has told me that quitting cigarettes (Camels, mainly) was tougher than quitting cocaine and heroin. I’m glad I never got started.

Hopefully, the health impacts of filling every processed food product we consume with grams and grams of sugar (especially high fruitcose corn syrup) will be seen as equally bizarre thirty years from now!

I’ve never understood adding sugar to fruit juice!

I’ve never understood adding sugar to fruit juice!

It… makes… the juice… sweeter…

Complicated explanation, I know. It’s okay though, I’m a trained nutritionist. Also a toothiologist.

@11: no way never happen… PETA would immediately slap an injunction all over the researchers

SHAWN at #13: wow had to be tough on your dad… quitting Cocaine, Heroin, and Tobacco?

My dad is still eating badly, chain smoking, and can’t function without two cups of coffee every time he wakes up – which is multiple times a day, because he can’t sleep right. But he hasn’t done any illegal drugs or alcohol in over twenty years. Tremendous. πŸ˜›

My step-dad also said quitting smoking (which he hasn’t accomplished yet) is much harder than quitting cocaine (quit on his own, cold-turkey, in his early twenties).

Since the plural of anecdote is not data, I’m curious if there have been any kind of comparison studies on the addiction to smoking versus addiction to other drugs?

@Brian M

I recommend the book The 100% Natural, Purely Organic, Cholesterol-Free, Megavitamin, Low-Carbohydrate Nutrition Hoax. Mostly because I don’t have any online resource I know that debunks the hyperbole about the “dangers” of sugar.

ISBN 0-689-70680-4
Elizabeth M. Whelan and Fredrick J. Stare, 1984

It’s ironic, nicotine, by itself, is not really a very addictive substance. Nor that harmful in chronic use – by itself.

Inject nicotine directly into the bloodstream, and it’s less addictive than dextromethorphan, the OTC cough syrup ingredient. Not a lot of fun, people/animals really don’t want to do it very much.

BUT… that’s not how people preferably use nicotine. They take individual puffs on a cigarette or cigar or pipe or hookah or whatever, each puff containing enough nicotine for a physiological reaction.

A one-pack-a-day smoker takes about 1400 puffs EVERY week.

And they take those puffs on a pretty set schedule, normally at times associated with other pleasures – like eating, breaks, coffee, alcohol, other drugs, sex, friends, sports, entertainment.

Take all that together and Pavlov’s dinner bell was child’s play.

One could barely design a behavior so well suited for addiction, not mainly via pharmacology, but via pleasure association.

I contend that smoking is an addictive behavior. It’s like how gambling can be an addiction, despite no chemical dependence. It’s an addictive behavior like cracking your knuckles, or biting your fingernails.

I quite agree, and…uhm…at least I don’t gamble. Much.

Take all that together and Pavlov’s dinner bell was child’s play.

Also well said.

Somewhat bringing together nurses, smoking, and history, see
http://www.shorpy.com/node/6690?size=_original
Back in the day, a nurse would give you a pack of smokes, and light you up, in the ward.

Shorpy pulls old photographs from the Library of Congress, cleans up the contrast a little (and not much else) and post them on the site. The photos go back to the beginning of photography, and up to the 1960’s or so – mostly early 20th century. There are over 4000 pictures to see, so pack a lunch.

The medical gallery on the site is often frightening. If you’re offended by horse poo, stay away from the street scenes. If you wonder why Paul Simon sang about Kodachrome, Shorpy has the answer.

I smoke, ride a motorcycle, and write truthful political commentary. Which should I quit first to have the greatest life expectancy?

Also, how would quitting said activity compare to the survival-probability of signing up with Alcor?

I keep hearing that smoking is ‘bad’, but nobody’s ever deigned to tell me with numbers; and like Heinlein said, if you can’t say it in numbers it’s just an opinion.

Don’t get me wrong, I’m sure it’s a significant risk factor, but how much of one? Because it’s a toss up whether I prefer smoking or drinking whiskey.

P.S. Aside from the anti-smoking, I love the blog. πŸ˜‰

How can we stop Nicotine addiction?

Now, let’s consider what false ligand nicotine is.
Yes, it is an acetylcholine faux ligand.

Next, how can we flood the CNS with acetylcholine to competitively compete with nicotine?

Why not a big slug of lecithin and pantothenic acid twice a day. Lecithin provides the choline and PAN the acetyl group.

Finally, how can we decrease craving? Wouldn’t combined dopamine and serotonin precursors (levodopa and 5-HTP) do the trick http://foxyurl.com/7Bh?

Would this combination work? Probably but no one will make any money.

Wasn’t the old line “Nine out of ten doctors prefer Camels”? Mad Magazine added, “The other would rather date a girl.” (Yes, that might be sexist, but there weren’t a lot of female MDs back then.)

Not much of an improvement, I guess: Nine out of ten doctors who tried Camels went back to their wives.

On topic: in ’64-’65 I had a lab-assistant job with a doctor who was doing pulmonary research along with his regular practice. He had fairly recently given up smoking and was rather an evangelist for not killing yourself in that way; these traits were not yet common at all. A while later he published a fairly early study on second-hand smoke, all while the industry’s captive research organization was still proving this cancer stuff was all a fake. What I recall particularly was once when I was sent over to his medical office and met the women (of course) on his office staff. He had banned all smoking in the office, and they were complaining good-naturedly about it. No doubt about it, it was hard.

Another thing to be not nostalgic about, rewinding a couple of years from there: When the previous class session cleared out, running into the conference room to open all the windows to start clearing some of the smell of putrid gym socks. Balkan Sobranies, I think they were called. Eventually, when the weed (tobacco, not that other one) was banned all over campus, the one holdout for a few years was the student-controlled student center. That was in the 90s; political radicals can be socially conservative, as has been noted before.

Pietr Hitzig

Now, let’s consider what false ligand nicotine is.
Yes, it is an acetylcholine faux ligand.

Oh dear!

Why not a big slug of lecithin and pantothenic acid twice a day. Lecithin provides the choline and PAN the acetyl group.

Just for starters…
Choline crosses the blood brain barrier? Citation?
The source of choline in acetylcholine synthesis is recycled acetylcholine (also catabolism of
phosphatidylcholine) which is degraded by acetylcholinesterase in the synapse. Reuptake is also rate limited at the choline carrier.
Sooooo….?
May be just a few (:p) problems with your concept of ‘flooding the CNS with acetylcholine to competitively compete with nicotine’!

Finally, how can we decrease craving? Wouldn’t combined dopamine and serotonin precursors (levodopa and 5-HTP) do the trick

Oh dear!

I’ve always been interested in the question of how to balance personal freedom with the public good. For example, I believe that smokers should be taxed substantially, but not in an arbitrary, bullying manner.

Pietr Hitzig,

You wouldn’t happen to be the same Pietr Hitzig, M.D. who lost his license to practice in both the states of New York and Maryland due to sexual misconduct, would you? (http://w3.health.state.ny.us/opmc/factions.nsf/58220a7f9eeaafab85256b180058c032/9eaf8ec2026b214985256a4a0047d64f/$FILE/lc106976.pdf)

Or the same “Father of Fen-Phen” who was convicted of illegally dispensing medications, and who based his entire practice on prescribing the dangerous combination fen-phen? (http://pacer.ca4.uscourts.gov/opinion.pdf/014895.U.pdf)

Or the same one, who claims (in the website you provided) to have been researching your PURSOR protocol for the past 15 years, yet has published nothing since 1996 (and that being a letter to the editor).

Just wanted to clear a few things up for our other readers here at Respectful Insolence.

Great post; I think it’s funny in how woo-peddlers and anti-vaxers will often point to “studies” like this as if to say “Even doctors can be wrong!” while completely missing the point; these studies have long since been discredited and discarded by medical science, while their woo and theories are often based on discredited ideas OLDER than these types of studies, yet they’re somehow exempt from being based on ideas proved completely false by modern science.

Oxeador,

In this instance, acupuncture and other CAM practices may actual be of some use. Part of recovering from addiction is finding ways to stop those urges from coming back. If acupuncture helps a person believe the non-physical cravings will stop, then it actually will help.

It’s one of those times when a placebo may actually help (depending on whether the patient actually believes it’ll help).

The thing that still astounds me is that when I was an orderly in a large Dallas hospital in 1978, not only did an apparent majority of doctors and nurses smoke, but every single one of the respiratory therapists on the hospital staff, on all three shifts.

How those people could go around all day seeing people suffering from smoking-induced emphysema and still continue smoking themselves, even taking smoking breaks between giving oxygen treatments — it just beggars belief.

(Then again, maybe that’s how they got started in that line of work — sort of like people going into the field of psychology because they were inspired by their therapists.)

~David D.G.

I agree with a comment above that gets across the point of nurses smoking often because it’s the only few minutes of break time they get. I think this happens in alot of workplaces, not saying it’s the only reason people smoke. But with anyone, including doctors, I don’t want to infringe on their rights just because they look the worse doing it. As long as they are working to find solutions for people wanting to quit that actually work effectively! πŸ™‚

Orac,

You clearly haven’t been following recent developments in epidemiology. Last year, P. Duesberg et al. published a stimulating article in the esteemed journal Medical Hypotheses. They irrefutably demonstrated that the populations of South Africa and Uganda have increased in recent decades, thus proving that HIV does not cause AIDS and has not caused any deaths in Africa.

It’s obvious to anyone who’s paying attention that the U.S. population is larger today than it was in 1810, despite the ubiquity of second-hand smoke during the past two centuries. Even more damning for the illogical tobacco-disease hypothesis is this: cigarette usage rates have been sinking and smoking has been (unconstitutionally!!) banned in more and more locations…..and the population growth rate has slowed. To an astute epidemiologist like Peter Duesberg, the inescapable conclusion is that cigarette smoke is harmless. In fact, the current lack of smoke-filled rooms is inevitably toxic.

Get your head out of the pharmaslutty sand, Orac, and help lead the way back into the golden age of science. We could even feature you in a new black-and-white advertisement!

Chuck:

At one job I worked at, one employee managed to talk the manager into giving her 5-minute “non-smoking breaks” πŸ™‚

Treating smokers and non-smokers the same way in terms of breaks would certainly be beneficial. If the smokers get a break, non-smokers should get the same break

I’m very glad I live now, or else I would have died then. *shudders* I’d probably have keeled over when I went to the doc to get my asthma treated – I react severely to tobacco smoke, and that’s when my lungs are well-controlled πŸ˜›

And yes, I think non-smoking breaks sound like a good idea. Everyone needs to get out in the fresh air a little ^^

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