Getting smokers to have a change of heart

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My life has been with learning experiences from several perspectives of the medical industry. Even though the experience has helped me conceptualize clinical medicine, public health and research perspectives on the deadliest voluntary behavior, I never understood the urge to smoke. Maybe it’s because I come from a non-smoking family where we always identified smoking as a risky behavior. It has always puzzled me as to why someone would want to smoke something that contains more than 4,000 noxious chemicals. When I practiced medicine in India, the patients who continued to smoke despite all sorts of cessation approaches frustrated me. I felt I wasn’t doing something right. Surely there must be some way I could help them help themselves.

So when I entered the academic clinical research sector at Emory University, I was eager to join a team investigating smoking and health. One of our studies that included patients from the Grady Health System found that six months after suffering from a heart attack, more than half of patients continue to smoke. I was shocked. Not even a heart attack could compel them to change their behavior.

Most surprisingly, the same study revealed that cessation programs work much better than healthcare professionals telling patients to quit.

This does not mean that physicians should stop advising patients to stop smoking. It means we need both. Physicians should keep offering advice, plus they need to refer patients to smoking cessation programs. In other words, patients need a regiment, not just a reminder.

My solution to the needs of the Georgia patients seemed simple. After wrapping up the study, I advocated for a smoking cessation program within the Grady Health System. The only glitch: I was immediately told that I went out of bounds. Apparently, my role as a clinical researcher is limited to the data. I had to hope that someone else would take the ball and run with it.

As luck would have it, I got the opportunity to do exactly what I wanted when I became a public health professional in Georgia. In my new role, away from number-crunching and into the community, I tried to do what health officials should do: change the social climate and promote a supportive environment. I pushed for smoke-free zones and other policies to protect individuals from second-hand smoke exposure. But even this community-based approach, alone, isn’t enough.

By now, I had seen each perspective working in different angles. The doctor’s perspective — the individual approach. The research perspective — the quantitative approach. The public health perspective — regulations. The problem, as I realized, was the splintering of duties and not enough interdisciplinary work. We have worked on a siloed approach for years and we still seem to have smokers.

And it’s not just the smokers. There is no denying that second-hand smoke causes cancers, heart disease, asthma and other diseases.

The CDC estimates second-hand smoke causes 46,000 heart disease deaths and 3,400 lung cancer deaths among American non-smokers each year.

Now is the time to take a synergized approach involving the entire community, and by that I mean physicians, public health professionals, businesses, researchers, smokers and non-smokers.

Only when we get everyone on the playing field, can we finally get the homerun we all need: Fewer people smoke, fewer people sick from second-hand smoke and improved public health for the whole community.


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