The war on tobacco use

Canadian Medical Association Journal 1996; 154: 141-142

[Letters]

In his letter "Courageous action needed to end smoking" (CMAJ 1995; 153: 1063-1064), Dr. John C. Acres proposes that the medical profession suggest to our political masters innovative approaches to the smoking problem. As an analogy, Acres refers to World War I and the battle at Gallipoli.

I agree with the spirit of Acres' letter. It is appropriate to compare the tobacco industry with the malevolent organization of the Kaiser's army. Unfortunately, the tobacco industry has proven more tenacious.

The active pharmacologic agent in tobacco is nicotine, which is widely acknowledged to be extremely addictive. Products containing nicotine should be classified accordingly; they should be treated in the same way as pethidine or morphine.

Federal legislation is urgently needed to make this change. I propose that the CMA and its members present such an idea to Parliament and pursue it closely.

Interim measures include an immediate ban on tobacco vending machines and the strict enforcement of laws prohibiting the sale of tobacco products to people under the age of 18.

To extend the metaphor, the Allies' early success in penetrating secret German and Japanese military radio codes played an important role in the final outcome of World War II -- research can play a critical role in the final outcome of the war on tobacco use.

For example, people with active hepatitis lose all desire to smoke. If we could find the mechanism that causes this change in desire, the drug company that markets the resulting drug could make great profits.

Robert Shepherd, MD
Gatineau, Que.

[The director of health care and promotion at CMA responds:]

I agree that federal legislation governing tobacco products is urgently needed. On Nov. 20, 1995, the CMA, Physicians for a Smoke-Free Canada, the Non-Smokers' Rights Association and many other groups led a march on Parliament Hill to highlight the pressing need for legislators to control the continued devastation caused by tobacco use. The foot soldiers in this particular demonstration were 40 medical students, recruited from the University of Ottawa, who carried signs and shouted, "Legislate, don't procrastinate," and "Tobacco kills." This event may have been their best education on prevention and public health. Along with the courageous and undaunted members of this coalition, they are to be thanked and congratulated.

In addition, these groups met with Health Minister Diane Marleau, who announced that she would propose strong comprehensive legislation to the federal Cabinet in December (see "Yes, Minister, Canadians need strong tobacco-control legislation now!," starting on page 191 of this issue [full text]). The CMA Council on Health Care and Promotion and Political Action Committees are now working on this issue in conjunction with the Board of Directors. So the battle for new legislation has begun, and, as Dr. Shepherd suggests, all of the intelligence assets, ammunition supplies, stealth technology and personnel, from generals to infantry, must be marshalled to the cause. Thank you for volunteering!

David J. Walters, MA, MD, CCFP
Director
Department of Health Care and Promotion
CMA

CMAJ January 15, 1996 (vol 154, no 2)