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Second Opinion
Dr Michael Fitzpatrick

Exterminate the filthy smokers

A key test of New Labour's commitment to public health approaches. Are prime minister Tony Blair and public health minister Tessa Jowell ready to take the hard choice to tackle the killer tobacco, the greatest single cause of premature death in Britain? Or are they going to take the soft option, as they did last year in exempting Formula One racing from the ban on tobacco sponsorship of major sporting events?

The facts are clear. Smoking kills 120 000 people in Britain every year, 3.5 million world-wide. The tobacco barons, dubbed the 'merchants of death' and 'corporate killers' by Sandy Macara chairman of the British Medical Association last year, are making vast profits out of the creation of disease. As health minister Frank Dobson told a Royal College of Nursing conference last year, they need to recruit more than 300 new smokers every day to replace the ones killed off by smoking.

In pursuit of new customers for cigarettes, the advertising agencies skilfully and cynically exploit the most vulnerable sections of society - children, women, people in Third World countries. To young people they offer fantasies of being cool and in control, to girls an image of slimness and sophistication, to the poor of the South a vision of Western chic.

Smokers are both victims and perpetrators of the tobacco slaughter. While they die of coronary heart disease, lung cancer and a dozen other diseases linked to smoking, the smoke they inflict on others - environmental tobacco smoke - also takes a heavy toll. According to some highly acclaimed epidemiological surveys, passive inhalation of environmental tobacco smoke may be even more dangerous than actively smoking between five and 10 cigarettes a day! A recent French study reckons that passive smoking kills 22 000 people in Europe every year (20 000 from heart disease, 2000 from lung cancer).

Now is the time for concerted action against the genocide! A major cancer research foundation recently calculated that between 1950 and 2000, the death toll in Britain will amount to six million. The perpetrators of the tobacco holocaust should be brought before an international tribunal, along the lines of the Nuremberg trials, or the hearings currently in progress in The Hague over war crimes in Bosnia.

Those, like RJ Reynolds, manufacturer of Camels, which targeted its propaganda on adolescents as young as 14, should be indicted together with Philip Morris, which claimed that passive smoking was no more dangerous than eating biscuits. They should be joined by their academic apologists who have repeatedly denied that nicotine is an addictive drug. Like the leaders of the Bosnian Serbs, they should all be hunted down and brought to justice. Those who bleat about civil liberties should ask themselves - what do the tobacco barons care about the human rights of their victims?

Developing countries, which, according to a recent editorial in the British Medical Journal, lack 'skills in tobacco control' and are 'vulnerable' to the tobacco corporations' 'aggressive marketing' tactics, need special protection. The model form of intervention here is the Gulf War task force, whose humanitarian brief could be extended to targeting tobacco sales outlets while encouraging popular health promotion programmes.

But what about smokers themselves? Here the New Labour approach should be not to blame them for their nasty habits, but to offer an opportunity to overcome them. Every smoker should be invited to attend special centres for counselling, including offers of ongoing anti-dependency group work and nicotine replacement therapy. Those who default should have a microchip tattooed on their forehead so that members of the public can easily recognise them and take immediate evasive action to minimise the health risk to themselves and their families. Statistics show that the committed smoker is also inclined to use cigarettes to importune children and women into other forms of illicit activity - involving alcohol, drugs, sex, crime.

The public has already endorsed some important initiatives against smokers, driving them out of homes, workplaces, public transport and other public places. It is now time for the government to take the campaign a step further. The boot camps opened by the previous government to deliver a 'short sharp shock' to delinquent youth did not prove successful. But they are ready to be reopened - on a much larger scale - in a drive to re-educate the nation's smokers. Recalcitrant smokers could be driven in trucks from the inner city estates where they are concentrated to these camps in remote rural areas. In Cambodia in the 1970s, Pol Pot, a pioneer of the new public health, used this approach to achieve a dramatic reduction in mortality from smoking.

It is fortunate that the new government has shown that it is capable of the sort of tough thinking necessary to devise a final solution to the tobacco problem. No doubt there will remain a hard core of those so corrupted by tobacco, its profits and its toxins, that they will refuse to give it up. Filthy habit, filthy people - they will have to be exterminated. The camps can then make room for all the other deviants whose behaviour is designated a major problem of public health - those who are overweight and not inclined towards exercise, those who drink more than the prescribed number of units of alcohol and take illicit drugs. Disposal will be a problem though - incineration might lead to an increased level of particulate pollution of the atmosphere and constitute a threat to public health.

Reproduced from LM issue 108, March 1998

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