That Thing About Blaming Smokers
I was fortunate enough in the 1970s to grow up in a smoke-free household. But not all my friends were so lucky, nor were so many people just one generation before me. In fact, from the 1940s through the 1970s, social smoking was often considered elegant, sophisticated, and downright proper. People were encouraged to smoke, not just by the tobacco companies, but by their friends and relations. Famous actors like Steve McQueen hawked cigarettes by brands claiming to be a "healthier smoke" that was "preferred by doctors" and other statements that would never pass the regulatory laws of today.
My family's history with tobacco
My grandmother, over the course of probably twenty years, had been encouraged to smoke by her husband -- who also happened to be a renowned surgeon in Chicago. Neither of them particularly cared for the act of smoking and neither of them did it in private, but he was very concerned with social appearances and demanded that they "enjoy" cigarettes when they were engaged in social activities. He felt that it made them look properly sophisticated, which was necessary for his social reputation and therefore reflected upon his professional reputation. As it was related to me, my grandmother took great pains to learn how to appear to enjoy smoking while mainly just holding a cigarette in her hand.
My mother's teenage friends in the 1950s did not perhaps exert as much social pressure, but she nonetheless found it necessary to try cigarettes. While her experience was sufficiently negative to ensure she had no interest in the habit, burning a hole in a favorite coat in the process, her mother's own aversion no doubt made it easier to avoid the pressure to "enjoy" smoking at a young age. As for my father, he was very sensitive to the smoke and suffered from some respiratory allergies that not only made tobacco use unpleasant but also ensured he could not have people smoking inside of our house.
Inescapable second-hand smoke
Growing up in the 1970s, I found that our home was a rarity in this "no smoking" rule. We had friends who not only routinely smoked at home, but in virtually every business, at restaurants, and in cars filled with children. There was no way to escape second-hand smoke, and in a closed vehicle it was almost the same as lighting up yourself.
At school, I recall when small posters began to appear with the slogan, "smoking is so glamorous" printed over a picture of a ragged-looking man with a cigarette. The implication was that the man was a bum, he looked terribly hung-over, and was definitely unfashionable. It was a weak attempt to counter the still pervasive image of the Marlboro Man or the fact that the heroes of movies were consistently seen lighting up. James Bond smoked, the most famous singers smoked, it was difficult to turn on even "family" programs on the television without seeing cigarettes presented as normal parts of life. When I was a teenager doing theatre in the 80s, my characters sometimes smoked on stage because it was an easy way to add some reality to the business. While students who wanted to hang out in "the pit" at my high school may have been labeled by some, it was a genuine smoking area for kids that was officially sanctioned.
Combating a culture of misinformation
We grew up in a culture where smoking was normalized. And while there were efforts underway to educate people about the dangers of smoking, there were decades of misinformation and media hype and willful denial about tobacco's perils to overcome. Although I never had pressure on myself to become a smoker, I had plenty of friends who chose to pick up the habit and no one ever really thought twice about it. Then, of course, they became addicted.
So now when I am asked whether I have lung cancer because I was a smoker, I bristle. Not because I hate being accused of smoking, but because the question is almost always posed in a way where smoking is used as a justification for the disease, a way to say that the patient earned it. But that is never the case. The vast majority of smokers today picked up that habit when it was considered a normal thing to do, surrounded by role-models who made it look appropriate.
It's time to remove the smoking stigma
Cancer is frightening, especially lung cancer, the ubiquitous killer. When people are scared, they want to place blame. And blaming the victim keeps the disease at arm's length. But it is the wrong thing to do.
Most of us were exposed one way or another, not just to tobacco, but to hundreds or even thousands of carcinogens. And none of us willfully received our diagnosis. None of us deserved it. Please understand that it does nothing to help the patient by asking, and it may even cause unintended harm. There are enough stigmas already tied to lung cancer, keeping patients quiet and hindering attempts to raise funds for research. If we are going to make progress, we need to remove the stigma.
So unless it is a clinical question, designed to help researchers collecting data about driving mutations, stop asking whether lung cancer patients have smoked. It does not matter.
Editor’s Note: We are extremely saddened to say that on October 21, 2018, Jeffrey Poehlmann passed away. Jeffrey’s advocacy efforts and writing continue to reach many. He will be deeply missed.
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