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Two Pandemics

A friend of mine once jokingly chided her mother for smoking around her when she was a baby. Her mother defensively stated that her doctor had actually smoked with her! We’ve come a long way since then, but despite progress in our understanding of the hazards of smoking, a significant proportion of the population continues to smoke.

The antismoking campaign that followed the 1964 release of the Surgeon General’s report on Smoking and Health is one of our greatest public health achievements. Initially, the report identified cigarette smoking as a cause of lung and laryngeal cancer; subsequent reports described the adverse effects on most major organ systems. This has informed policies and programs related to the smoking pandemic, such as health warnings on tobacco products and the ban on advertising.

We are currently living through another type of pandemic, and probably the greatest public health crisis of our lifetime. Unfortunately, public health efforts have been hampered by misinformation and conspiracy theories. Shortly before I wrote this essay, someone (without knowing I was a physician), told me that there was no pandemic, and advised me to “turn off the TV.” I politely but firmly informed her that I was a physician and hadn’t watched TV in months, adding that, while she was free to believe what she wanted, our hospitals and ICUs are not TV. While people are free to believe and act as they choose, disease–whether virus-borne or tobacco-related–is no respecter of persons.

When the COVID-19 vaccines were initially rolled out, some argued that smokers should not have been prioritized despite their higher risk, since smoking is a personal choice. As healthcare professionals, we are required to do what is in our patients’ best interest, even when they have not made the best choices. Similarly, we have a responsibility to care for pandemic deniers and those who are unvaccinated or refuse to wear masks when they get sick.

I wonder how future generations will view our response to the current pandemic. Just as my generation looks back and wonders why doctors encouraged patients to smoke and allowed mothers to expose their babies to second-hand smoke, future generations may question why so many people chose conspiracy theories over science and public health. Did we as healthcare professionals lose the trust of our patients by failing to communicate effectively?

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