It happened half a century ago, but it seems as if it was yesterday. Our next-door neighbor, Pam, a tomboyish teenager who was uncontestedly the best football player in our village, came to see my mother during my school lunch hour. I was in our back yard, feeding lettuce and purple clover to my pet tortoise, Sammy, observing his gaping jaws as he devoured his feast.
Sensing a crisis, I peeked through the kitchen window. Pam was enveloped in my mother’s caring arms. “This is dreadful news, luv, but know that I’m always here for you if you need me, and promise me right now, luvvy, that you won’t ever smoke those rotten, filthy, disgusting, cigarettes!”
I felt nauseous and sad, so very sad. The last time Pam came to see my mother during my school lunch break was when her mum accidentally set fire, with a burning cigarette, to the newspaper wrapping up her fish-and-chips, incinerating in one horrendous moment a precious ten-pound note in the process. That was a whole week’s salary for Pam’s mum- gone in a puff.
This time it was much more serious. That morning, Pam’s mother was told she had six months to live, if that- she was dying of lung cancer. Pam’s father died five years earlier from lung cancer, and now it was his widow’s turn to face up to that familiar fate of pain, indignity and progressive emaciation; and their daughter was to become a tobacco orphan.
I remember Pam’s mum well. She influenced my life, and- believe you me- not in an insignificant way, by just a few words she spoke to me a year earlier. Cruelly, I was about to kill a ladybird in our garden, when she said, “Don’t harm it, mi darlin’, it’s one of God’s most beautiful creatures.” I never forgot those words, which seem ironic now, considering that she lost her life through the tobacco industry’s neglect of God’s most beautiful people.
Mind you, I felt that I was an accessory to the cigarette company’s crime, because I had, many times, run errands to the corner shop for Pam’s mum, to buy her a pack of ten Woodbine, or “my coffin nails” as she called them. During one of those errands, I went to the village library to look up “woodbine” in an encyclopedia, and I struggled to understand how that poetic and fragrant wildflower could be equated with its noxious cancer-causing namesake.
On my way back to school that crisp Spring day I stopped by the village sweet shop, owned by Mr Prim, a plump, well spoken, well educated gentleman, who wore the same mustard suit, mustard tie and mustard shoes that he wore always. He smoked cigarettes and cigars, and he was performing his weekly ritual of locating a clean area of his hanky, spitting into it, then aggressively wiping off the “tar” from his yellow-stained fingers, which, curiously, matched perfectly his attire. I’d made a resolution several years prior to then never to buy unwrapped sweets from Mr Prim.
Candy cigarettes were popular then. The crunchy white sugary sticks with red ends, which were sold in packs closely resembling the ones real cigarettes came in, could be pretend-smoked then chomped and swallowed. Then there were those cardboard tubes with scrunched up silver foil dyed orange at one end, made to resemble glowing cigarettes. You couldn’t eat them, but when you blew into them some sort of powder came out, creating a semi-realistic puff of “smoke.” My favourite, though, was that sweet, brown, stringy coconut-flavoured “loose tobacco.”
I could tell you then with great pride, and I can tell you now- ashamedly, though- 50 years on, what brand of cigarette each smoker (and there were plenty of them) in our street preferred and I could describe the colours and designs of all of the cigarette packs available then. I marveled at the sophistication, richness of colours and elegance of the logos on the packs. My dad smoked Benson and Hedges (“B & H”), which were almost as popular as Woodbine (“Woodies”). Mr Barmey next door, and Mr Jackson and Mrs Fields who lived opposite us, all smoked Capstan Full Strength. Mr Crawshaw, my dad’s best pal, smoked Piccadilly, which brought to my mind that well known fashionable area of London.
Every Sunday my father took me to see my Uncle Bill, who shared a council house with another relative, Fred. Whereas Uncle Bill was a devout non-smoker, Fred was a chain-smoker. Sometimes he would even have two cigarettes simultaneously perched between his lips. I never saw him not smoking except when he was eating, his knife and fork preventing him from holding a cigarette.
The atmosphere in Uncle Bill’s living room was always hazy with exotic pastel blue, grey and white twists and swirls of smoke, emanating from a resting lit cigarette or from Fred’s forced exhalations. Sometimes, especially when I stopped listening to the hugely important sociopolitical and philosophical discussions of the adult trio, I passed my time creating images of demons and genies out of the choreiform dance of cigarette fumes. Uncle Bill’s two pet budgerigars, I thought, must really suffer, because even I- a substantially bigger living organism- felt ill just from sitting there for a few hours, and it was such freedom for me to get out of that house, into the fresh Yorkshire air. Peter and Polly, though, not only were deprived of their right to fly, but also were exposed to that irritation all day, every day. Maybe that was why their chirps were especially loud and harsh.
Fred was a good man, you can be sure of that. He loved discussing politics and the meaning of life with my dad and Uncle Bill. I remember especially his unswerving support for the working class, the poor, the kids-of-today, old aged pensioners, and disabled people.
Fred never became a pensioner. He died of lung cancer just before his 57th birthday. At his funeral, Uncle Bill said, “Our Fred was a good ‘un, ‘e was, but ‘e smoked like a blinkin’ chimney and ‘e suffered for too long. It was a blessin’ when he passed away and I ‘ope he can’t smoke on t’other side.”
A decade later, Uncle Bill, who never took a single puff of a cigarette in his entire life, but surely was one heck of a passive smoker, died also of lung cancer.
Every Wednesday night I accompanied my mother to her bingo game at our village church hall. It was a break from my homework and I was treated to a bottle of pop and a bag of cheese-and-onion crisps. Father Francis, the priest who called out the numbers, smoked throughout the bingo session, taking emphatic inhalations then coughing so loudly that it made the microphone screech, this between “Kelly’s eye” and “Number One,” or “Two fat ladies” and “Eighty-eight.” Father Francis smoked Pall Mall.
For years I saw an ear, nose and throat specialist for recurrent middle ear infections. She was clueless as to the cause of them. The damage caused to my hearing by these recurrent infections was severe and by the time I was 11, I required a hearing aid, and have worn one to this day. That was decades before passive smoking was shown to be highly linked to childhood ear infections.
Tobacco came as a deluge, though, when I became a physician. I can recite, with no hesitation, a long list of my patients who suffered at the merciless hands of the tobacco giants. Joe, a successful restaurant owner, was robbed of his business and life after he suffered extensive, deforming third degree burns when his bed caught fire while he was smoking. Then there was Eddie, who came in with double vision and found just days later that he was riddled with metastatic lung cancer; he died within weeks. There was Vera, who coughed up blood for six months before her first visit, and discovered just an hour later that there was a massive lung tumour on her chest X-ray. There was Martha, who ignored her hoarse voice until it was too late to treat her invasive laryngeal cancer. Then there was……..well, there were many, many more tobacco victims who passed through my practice.
Tom Backley was one of those dear patients I saw often enough to become his close friend as well as his doctor. Charming, educated and respectable, in his early seventies, he had been CEO of a prominent investment company. For 45 years he smoked a pack of cigarettes daily, but he quit when he was in his late fifties, just after his first heart attack. After his second heart attack he underwent coronary artery bypass surgery, and after his third one at 68 he was left with severe congestive heart failure. His prognosis wasn’t good at all.
Tom deteriorated predictably, to the point where he couldn’t even get up from a chair without having severe shortness-of-breath, and it was certain then that Tom Backley’s life was almost over. I had a hospice nurse visit him, but since he lived just down the street from me, I visited him every other evening after work. He had a gin-and-tonic waiting for me every time. I loved to hear him reminisce and profess his eternal love for his wife, who died 25 years previously in a car accident just as her career as an opera singer was blooming. Photos and portraits of her adorned his apartment.
I watched him fade away, but I learned something profound from Tom Backley. “Doc,” he confided, “I accept that I’m dying, but I have no peace. All night long I’m haunted by things I did in the past; I sweat to the point of drenching my bed sheets, and I weep despairingly. In my life, Doc, I cheated a few people and manipulated more, all so that I, my company and its shareholders could become rich. And now the money means nothing and I wish I could undo what I did, but I can’t.” I wondered whether Tom’s words might echo, during their dying days and much more appropriately, those who run the tobacco industry.
When, a few years ago, I came to Ethiopia as a volunteer to teach medical students, I thought I might be in a place where tobacco’s influence would be minimally visible, especially because Ethiopia ranks in the bottom five countries with the lowest smoking prevalence. Soon, though, prominent posters advertising Rothman cigarettes, a product of British American Tobacco (BAT), appeared on the fronts of roadside shops near my home. Within a month, hundreds of them appeared all over Addis Ababa, seemingly decorating the city and in perfect view of many impoverished teenagers, drably dressed in rags. The posters were pulled down in the ensuing months, after Ethiopia ratified the World Health Organization’s Framework Convention on Tobacco Control treaty, but BAT executives knew that those posters were illegal in Ethiopia. They would be illegal in Britain, too. I contacted BAT through my UK district’s Member of Parliament. A BAT senior executive responded, stating, “We take all reasonable precautions to avoid appealing to youth.” Did he really think that I was foolish and naïve enough to believe him?
In the beautiful country of Ethiopia, also, as a university professor, I accompanied two of my MSc students to their rural home towns, where we carried out several research projects on smoking and passive smoking practices. It was a huge eye-opener to find that, although Ethiopia has a low smoking rate compared with most countries, passive smoking is common. Many male smokers smoke in their homes, which contain small, poorly ventilated rooms, which put the passive smokers at a high risk for health problems. In one home, consisting of just a single room, there were nine children, all of whom were exposed for many hours daily to their smoking father, and his wife also was similarly exposed. We tested for metabolites of tobacco in the urine of many of these children and wives of smokers and found, to our horror, that over a half of them had levels of those metabolites equivalent to levels found in men who smoke a pack of cigarettes daily. What this means is that, in many households the number of effective smokers is increased by the number of passive smokers, so that in that family of 11 people there were 11 effective smokers: 10 passive smokers and one active smoker.
I had a few fascinating conversations with many impoverished, raggedly dressed men in the Ethiopian countryside about their opinion of tobacco. One group of men said they wanted desperately to quit smoking but have been unable to succeed. “We even dip our cigarettes in petrol,” one of them said, in order to make them nauseous and stay off cigarettes for a few days. But, he said, they always start smoking again. Many of them were spending a substantial proportion of their meager income on cigarettes: one man earned 20 birr (one US dollar) a day but spent 5 birr of this- a quarter of his salary- on cigarettes. “You have to help me quit!” he pleaded, but smoking cessation medications were not available to him. The only advice I could give him was for him to wean off the cigarettes by gradually cutting down the number he smoked, and to be strong willed, knowing that he could save precious money by quitting and that the money was better in his pocket or spent on his family than in the bank accounts of tobacco companies.
Recently, just for fun, I searched for my name on the Tobacco Legacy Documents Library, a digital archive of tobacco industry internal documents. Astonishingly, I discovered that, 30 years ago, my postdoctoral research project, including three years of my salary, was funded by R. J. Reynold’s tobacco company, through a grant given to my supervisor at the time. I never knew it then, and I was flabbergasted that my career was funded in part by Big Tobacco, and therefore by its victims.
During our daily routines we might forget the century-old epidemic that the tobacco industry has insidiously and wickedly wrought upon the human species, all because of the greed of tobacco executives and those others who are paid handsomely by the industry, shamelessly neglectful of the tens of millions of people who suffer and die from their addictive and poisonous products. We may be too busy to ponder the environmental impact of over four trillion cigarette butts washing into the world’s waterways annually, or to remind ourselves of the millions of precious childrens who work as child labourers in tobacco fields around the globe. We forget that tobacco kills more people than any other preventable cause of death on this planet and that, by the end of this century a billion people will have died from the Tobacco Plague.
But we can be certain of one thing: that the relentless monster otherwise known as the tobacco industry is somewhere close by, lurking in our midst, taunting us and perpetually, recklessly spewing out its addictive and deathly toxins.
All names used are fictitious but they are based upon real individuals.