Wednesday, August 10, 2005

Why Are They So Surprised?

An article from CNN on the stigma of smoking and cancer:

"When people get breast cancer, people say, 'What can I do to help you?' When people get lung cancer, people say, 'Did you smoke?"' said Susan Mantel, executive director of Joan's Legacy, a fund-raising group named for Joan Scarangello, a nonsmoker and former head writer for newsman Tom Brokaw. Scarangello died in 2001 of lung cancer, as did her nonsmoking mother before her.
"There is a definite stigma," said Labrecque, recalling comments after the funeral for his father, a former chairman of Chase Manhattan Corp.
"People would say, 'I didn't know he smoked,"' he said.
His foundation's Web site even acknowledges this trend, by stating that more than half of people newly diagnosed with lung cancer each year have either never smoked or quit smoking.
Doctors who treat the disease, like Dr. Bruce Johnson of Dana-Farber Cancer Center in Boston, bristle at the notion of "innocent" and "not so innocent" victims.
"People who smoke don't deserve to get lung cancer, and people have worked very hard to quit," he said.
Nonsmokers who have surgery for their cancer have a lower risk of developing a second tumor than smokers. Also, smokers who quit after cancer surgery have better survival odds, he noted.
Nonsmokers also respond better to Iressa and Tarceva, said Dr. Alan Sandler, director of thoracic oncology at Vanderbilt-Ingram Cancer Center in Nashville, who has been involved in testing these new-generation drugs that more precisely attack the molecular factors making these cancers grow.
"The malignant cell in a smoker is much more complex" and has more mutations than nonsmokers tend to have, Sandler said.
Researchers now are studying whether nonsmokers do better in general on chemotherapy than smokers, he said.
Meanwhile, the cancer society is hoping for an eventual decline in lung cancer cases to mirror the decline in smoking rates.
"Cigarette consumption is down where it was at the start of World War II. About 1 in 5 people are current smokers," Thun said.
"Lung cancer death rates have fallen 17 percent in men from 1990 to 2002. Both incidence and death rates have leveled off in women, so we are turning the corner."
As for stigma, he would rather see it on those who sell cigarettes than those who use them.
"If there's blame to go around, most of the blame falls on the tobacco companies," Thun said.


My only comments are, Why are doctors so surprised when people assume that lung cancer is a natural outcome of smoking? Lung cancer, by itself, was not a common disease before tobacco came into the culture we live in. Now that it has, tobacco is well-documented as having harmful and addictive properties. People ought to know-- and this article makes it fairly evident that they do know-- that if they fool with tobacco they can expect certain consequences. Why shouldn't we assume that if a person has lung cancer that 80% of the time it is because they smoked, or were around alot of smoke? And why shouldn't we assume that that person was stupid to smoke?

Both my parents smoked, and both died from lung cancer. I spent alot of time around cigarette smoke as a kid, and today I have a strong tendency towards bronchitis whenever I get sick. It's possible, that even though I have't been around smokers for 30 years, I could still get lung cancer. Why should I be upset if someone assumes that if I do get cancer, I was or am a smoker and it's my own fault? There should be a stigma to smoking, but obviously, only for those who have a choice about it. And everyone who smokes has a choice about it. It's the folks who put up with it who do not. If I do not smoke and had no choice about inhaling it as a kid, why should I get upset if some dumbbell thinks it was my own fault if I get cancer? After all, I have no problem saying that my parents were pathetic tobacco addicts who paid the ultimate price, and that I still may be paying part of that price. They were human beings, and they were weak. But they were responsible for their habits, not tobacco companies.

I also had a friend who died as a young woman from lung cancer. You'd never guess she would have, either: she was a health freak who biked about six miles to school and back every day, brilliantly intelligent and gentle, and decided to be a sheep farmer in Vermont, living out in the fresh air and having lots of outdoors activity. She died before age 35. Not a smoker. She would not have been upset to hear that people thought she smoked. She probably would simply have set them straight, that not all who get lung cancer are smokers. Then, likely she would have told people not to ask for the un-asked-for trouble she got by smoking like fools.

Making tobacco companies responsible for lung cancer in smokers is like making car manufacturers responsible for speeding and car accidents. We know how to operate the things; if we do stupid things in cars we die. Our responsibility. I have no problem on placing a stigma on idiots who drive poorly. And if my kids get killed because of doing something stupid with a car, I will cry not because they were "victims", but because they were stupid enough to not value their lives as I value them.

Death is a tragic waste, but we have more power to avoid it than we like to think.

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