I have to ask…As a Pediatrician, how did you become interested in treating adult smoking patients?

I actually started treating adult smoking patients during my Pediatric training at the University of North Carolina.  Even then, we know the dangers of second-hand smoke to our Pediatric patients… especially children with asthma.  So, we were taught to offer nicotine gum, which was the only available treatment at the time, to the parents who smoked around their children.

During those years, I can tell you that I never had one single parent quit smoking.  Looking back on it now, I can tell you that it is because our clinic offered no support to those families.  Handing someone a prescription for gum and wishing them well did not work then, and it doesn’t work now.

Since that time, it has become increasingly evident that passive smoke exposure leads to more illnesses, longer illnesses, and unnecessary deaths in non-smokers.  Yet, most Pediatricians, like our Family Practice and Internal Medicine colleagues, do not even bother to try and tackle the problem.  For the most part, treating tobacco addiction is almost too big of a problem to handle in a primary care setting.

 

So, what motivated you to try and take on such a huge problem?

Because there is no bigger, preventable health problem facing our country.  Over 444,000 Americans die prematurely every year from an illness caused by tobacco.  On average, those patients lose 15 years from their lives.  The total number of deaths from all other preventable causes combined is around 250,000, or 56% of the total deaths caused from smoking.  And that number includes deaths from alcohol, car accidents (including drunk driving accidents), fires, AIDS, heroin and morphine overdoses, suicides, homicides, and cocaine and crack.  

Think about that.  We fight a war on drugs to stamp out heroin, cocaine, and marijuana. Yet combined, those three drugs account for only 5,700 deaths annually, a meager 1.3% of the total deaths caused by tobacco.  It would appear that we are fighting the wrong war at the wrong time!  Not only does this motivate me to try and tackle the problem, it makes me want to build an army to fight the battle.

However, in a typical primary care office, this war is not being fought.  Instead, it is being ignored.  In a recent survey, only 15% of patients reported that their doctor had asked if they smoked and encouraged them to quit.  The problem is that most of the remaining 85% of patients took their doctor’s silence as tacit permission to continue to smoke.  In other words, if the doctor doesn’t bring it up, the patients believe that it must be okay to smoke.

 

I am guessing that you do not ignore the problem at Quit Doc?

Just the opposite, in fact.  The Quit Doc Smoking Treatment Network is designed as a dedicated resource to help patients quit smoking.  Following the quidelines published by the US Department of Health and Human Services, we combine medical management with long-term counseling and support.  Unlike a busy primary care setting, where the physician is trying to piggy-back treatment for tobacco addiction on top of something else during an all-too-brief office visit, we offer a comprehensive program that give tobacco addiction the attention that it deserves.  We pride ourselves in being a resource for busy primary care physicians who do not have the time to try and treat these patients on their own.

 

So, how did Dr. Voelker recruit you to be a part of his network?

I have known Kirk Voelker for over 20 years.  In fact, we were medical school classmates at The University of Florida College of Medicine. 

After I completed my Pediatric training, I moved to Los Angeles, where I worked as a medical consultant on film and television projects.  During the development of the SMART Shot ®, Dr. Voelker asked if my consulting firm would be interested in developing educational materials for his original Sarasota office.  As we explored this, it became clear that the target audiences for many of these educational materials were middle school and high school students.

 

Why?  Why students?

How do you think Big Tobacco replaces the 440,000 dedicated customers that die each year?  By marketing its products to children.  Despite all the hoopla surrounding the tobacco settlement, Big Tobacco still convinces 1.3 million children between 12 and 17 years of age to start smoking each year!  When you pick up a cigarette as a teenager, you are condemning yourself to a lifetime of addiction.  If we really want to win the battle against Big Tobacco, we have to prevent children from taking that first drag from a cigarette.

If you ask Sixth-graders what percentage of their peers smoke… what percentage of Sixth-graders smoke… you will hear astounding numbers.  40%.  60%. 80%.  The reality is that only 2% of Sixth-graders smoke.  For that matter, only 22% of adults smoke.  So, why are these children guessing such high percentages?  They are certainly not seeing 80% of their peers smoking.  The answer is in the media’s portrayal of tobacco use.  Smoking appears in a very large number of movies aimed at children, including animated films!  That number has risen markedly since Big Tobacco promised not to advertise to our children.

Big Tobacco has been linked to this increased use of smoking imagery in G, PG, and PG-13 movies.  Often, the depiction of smoking is brief, but it is portrayed as a normal part of life.  Rarely are the negative consequences of smoking shown in films or on television.  So, much like adults interpret the silence of their doctors as approval to smoke, children interpret the use of tobacco in films as normal behavior.

 

So children’s education programs are part of Quit Doc?

Absolutely.  Instead of consulting for Quit Doc, Dr. Voelker convinced me to become a part of the network with the goal of developing school-based outreach programs.  We currently present the Tar Wars program, a tobacco education program developed by The American Academy of Family Physicians, which focuses on tobacco advertising.

Early in 2007, we formed the Quit Doc Research and Education Foundation.  The Foundation will spearhead the efforts to educate children.  We are currently developing an educational program to show children how the depiction of tobacco use in films and TV shows influences their attitudes toward smoking.

And, if we do our job well, we hope to put the Quit Doc Smoking Treatment Program out of business in a couple of generations!