What have Betty Grable and Humphrey Bogart got in common? They both died prematurely at 57 years of age, victims of tobacco-induced cancers. And while they are instantly recognisable celebrities, film stars represent just the tip of the iceberg where deaths attributed to tobacco are concerned.
Worldwide, about four million people die prematurely each year as a result of smoking. In Europe alone 1.2 million people annually succumb to the deadly effects of cigarette smoke.
The death toll, by cause, is divided as follows: 38 per cent is attributable to cancers, with lung cancer the most common type; 34 per cent is associated with diseases of the heart and circulation; and 28 per cent die of respiratory disease.
In a neat calculation at the beginning of this year, scientists at the University of Bristol estimated that each cigarette reduces a smokers life by 11 minutes. The calculation was based on the difference in life expectancy between male smokers and non-smokers and an estimate of the total number of cigarettes a regular smoker might consume in his lifetime.
The research team found a difference in life expectancy between smokers and non-smokers in England and Wales of 6.5 years. The typical man consumes 311,688 cigarettes in his lifetime.
These rather crude but revealing statistics disguise the deep misery which tobacco can cause to humans. Smoking-induced cancer and heart disease have been well publicised, but for many doctors one of the most distressing deaths they will experience is that of a lifelong smoker dying of respiratory failure. The desperate anxiety etched on the face of a victim gasping for breath is a defining moment in any young doctor's career.
Why do so many people continue to smoke despite the well publicised dangers to health? The answer to this question is obviously complex, but it encompasses the clever marketing of the tobacco industry, the nature of nicotine addiction, the power of peer pressure and the response of the medical profession to the challenge of smoking and health.
The deceit of the tobacco industry is well documented. It continues to deny that nicotine is addictive and it continues to target teenagers in its marketing. Tobacco companies still perpetuate the myth that low tar cigarettes are safe. There is evidence to suggest the industry mounted a disinformation campaign when the issue of passive or secondhand smoking being a public health hazard was first suggested.
While peer pressure is in itself a powerful incentive for young people to smoke, internal tobacco industry documentation suggests they set out aggressively to manipulate peer pressure to make young people smoke particular brands. The importance of young people to tobacco companies is shown by the statistic that 90 per cent of smokers start the habit before the age of 20.
Nicotine is as much a drug as cannabis and heroin. Proof that withdrawal from smoking can be attributed to nicotine is shown by the consistent finding that withdrawal symptoms are relieved by nicotine replacement therapy (NRT) but not by a placebo (a patch that does not contain nicotine). NRT has been shown to double the chance that a smoker will be able to kick the habit. It is now available in a wide variety of formulations, from inhalers to patches to tablets.
Yet, in this State, NRT is not available free to medical card holders, even though they can receive free all of their medications for lung and heart diseases caused by tobacco.
If the Minister for Health, Mr Martin, was to make one bold move today, World No Tobacco Day, it would be to make NRT available to medical card holders, a group with one of the highest smoking rates. This would also send a powerful message on the issue of inequality in healthcare.
The medical profession must target smokers in preventive health programmes as never before. The Irish Cancer Society, the Department of Health and the Irish College of General Practitioners have come together to form the Smoking Target Action Group (STAG) and its principal initiative has been the training of family doctors in smoking cessation techniques. Motivated smokers can now receive targeted help from their GPs.
Much remains to be achieved in the area of smoking and health if a World Health Organisation prediction of 10 million deaths annually by 2030 from smoking-related disease is to be challenged.
The Legacy of tobacco Abuse is the title of a lecture to be presented today at the Mater Hospital's Freeman Auditorium by Dr Desmond Carney to mark World No Tobacco Day. It takes place at 7.30 p.m. and is free of charge and open to the public.