Do not smoke cigarettes

My uncle and tobacco

Tobacco is the number one enemy of public health in Okinawa.

I often hear the question "Why did you enter medical school and became a doctor?” Let me just answer this question with a narrative. When I was in the first grade in elementary school, I felt like I wanted to be a doctor. At the age of 6, I suffered from acute rheumatic fever, and had an inflammation of the heart, and valvular disease. When I visited a clinic, the doctor told me: "I can hear noises (murmurs) from the heart, but I cannot see them".

During this critical time, we received a message from my cousin who has been working in Kyoto and asked me to come to hospital in Kyoto. Right away, my father and I decided to go to Kyoto. We visited a hospital in Kyoto and met with the doctor for the first time. The doctor did follow the standard procedure like my chief complaint, history of the present illness, physical examination and auscultation using stethoscope, etc. When everything has been examined, the doctor finally made his diagnosis and ready to reveal his findings. My father and I anxiously waited for that few seconds. And suddenly we heard powerful words from my doctor: “this is no big deal anymore”.

That was the biggest assurance the doctor gave us about my present health condition. Upon hearing the doctor, my father immediate got relieved from uncertainty of my health condition. Because of this remarkable impression the doctor gave me as a first-grade elementary school student, I thought "a doctor was amazing". At that time, I started gradually longing and hoping to become a doctor in the future.

After few years, I entered junior high school and decided to consult with my uncle (the father of my cousin who asked me several years ago to go to Kyoto hospital) about entrance exam to medical school. My uncle was active in the community and was a chairperson of local education. His advice was very helpful for my future medical entrance examination. With hard work in school and great advice, (thanks to my uncle) I was able to pass successfully the entrance examination and admitted to medical school.

Aside from being an active person in the community, my uncle enjoyed tobacco/cigarette (smoking) since he was young. Through many years of smoking, my uncle, who gave me a guidance in preparing for entrance exam in medicine, developed emphysema (chronic obstructive pulmonary disease) due to smoking. It was a sad news to the entire family members and relatives.

For the meantime, I graduated from medical school and became a doctor. During my clinical practice at a hospital in Okinawa, my uncle was hospitalized with acute exacerbation of emphysema of the lungs. Due to complication of emphysema, he died in the hospital. I got so frustrated and felt so sad and sorry for my uncle. He could have lived a longer and healthier life if he did not smoke. My father also smoked during that period. He stopped smoking when he saw my uncle’s condition and finally died in the hospital due to smoking.

Smoking and its consequences in the world 

The smoking rate in Japan and European countries has declined over the past 60 years. On the other hand, the sad reality is that smoking rates are rising in 40 countries. Tobacco smoking has been recognized for many years without doubt: it causes sickness and death by the millions of people in the world. Smoking is the single biggest cause of death. And yet the prevalence of cigarette smoking has not decreased dramatically. Why?

The first factor is that the government actions are still insufficient in preventing smoking. Educating the general public and smokers intensively and extensively about the toxicity of smoking is not effective. Raising cigarette taxes; no smoking in public places; and supporting the people who would like to quit smoking are proven effective.

Although WHO recommends cigarette tax of 3/4 (75%) of the retail price or more, the tax rate of tobacco in Japan is about 65%, but it is still relatively higher compared to low tax rate among developed countries, resulting in low tobacco prices.

The Review Committee of the Ministry of Health, Labor and Welfare reports that "It is important to lower smoking rate (no. of smokers) by raising the tobacco price and tobacco tax now; and that we need to continue making efforts to realize that."

The second factor is the pressure from the tobacco company. The American movie entitled: "Insider" (directed by Michael Mann, and starring Al Pacino and Russell Crowe, shown in 1999) depicting anti-social pressure and misleading campaign by tobacco company was a real story. For example, cigarette companies do business by misrepresentation and deceit. The companies usually use brand strategy such as "light", "slim",’ "mint", but the harm to health is the same.

The third factor is the difficulty to change the behavior of smokers. In addition to public education, promotion of smoking cessation among the outpatient is important. Understanding that smoking is a disease called nicotine addiction is a prerequisite. All smokers must recognize that addiction is a disease. In public places, it is important to introduce a complete non-smoking rule.

Most domestic airports, cafes and restaurants have introduced smoking designated areas in Japan. Non-smoking rule is more important to introduce in public places like in Western countries.

In conclusion, it is a top priority to support smoking cessation, due to the extremely high morbidity and mortality caused by tobacco. More than 6 million people in the world die each year; and it is estimated that 8 million people in the world population will die every year by 2030, unless the smoking rate remains as it is. Many of the mortality would come from people in developing countries. The world needs to unite and create a movement that could focus on smoking cessation. China with its biggest number of smokers (1/3) of the population started a powerful non-smoking campaign.

My own proposal is to ban smoking in all public places. Government bureaucrats in the world must also start non-smoking rule during work, inside and outside their buildings. Smoking ban could prevent millions of sickness and save millions of lives.

By the way, the first-grade elementary school boy was Dr Yasuharu Tokuda.