Why Does France Turn a Blind Eye to Smoking?

One of my goals for a Gap Year has been to view the world and my self from a different perspective, to force myself to be different from the conservative and quiet private practitioner. I have been looking for a different voice. That is why I have been participating in the blogosphere, a world apart from my former self.

And that is why, dear reader, I am subjecting you to a series of rants on healthcare topics about which I feel passionately. Brace yourself.

On this Euro trip I noticed a resurgence of smoking among the young, meaning anyone less than my age.

It seemed particularly prevalent in France where crowds of high school-aged students clustered smoking on side walks between classes and where almost every well dressed female walking down the boulevards had a cigarette in her hand.

On previous trips I have noticed that smoking is more common in France and England than in the US but on this trip I have sensed a dramatic bump on the streets of Paris. Quickly googling around Wikipedia and various blogs support my impressions. Food writer David Lebovitz quotes chilling statistics about the problem in his blog, Living the sweet life in Paris. He states that 50% of French teenage girls smoke.

As a physician, I am confused by this development and outraged that tobacco companies are allowed to continue the dissemination of their poisons.

How does the social and political dynamic of a country as advanced as France allow tobacco sales to increase to children? How do first world countries continue to allow tobacco producers to exist and how can we turn a blind eye to the marketing of their products in the third world? How do tobacco executives live with themselves knowing that their products cause more death and destruction per year than any natural disasters?

The New York Times reports that the World Health Organization attributes over five million deaths annually to smoking; more than AIDS, tuberculosis, and malaria combined.

Recognizing that the single most important healthcare development of the last 50 years is the reduction in tobacco consumption and that reductions in U.S. cancer rates, lung disease and cardiovascular disease are directly, and primarily, the results of less smoking is argument enough to close down these enterprises.

Of course, we have not really “turned a blind eye.” Attempts to achieve this goal through education, tax increases and limitations placed on advertising seemed to be succeeding and my presumption was that ultimately tobacco use would diminish if not vanish. My recent travel experience says otherwise.

Simultaneously we read in the New York Times that tobacco companies are strong arming third world countries into eliminating or delaying legislation that would slow tobacco sales by threatening lengthy and costly litigation over trade treaty violations.

Ultimately the arguments of “free choice,” “free markets,” “legal product,” “free trade,” “free society” must lose their grip on us. The choice to try the first cigarette is not “free” because that choice is manipulated by the vast PR resources of the industry. The “free markets” do not exist because of “strong arm” tactics referenced above. The subsequent choices to continue smoking are not “free” because each dose of the most addictive “legal” substance available without prescription is influenced by the last dose.

If the tobacco industry were actually shrinking and on the road to elimination I could live with a continued slow decline but to see it re-energized in a first world country is intolerable. We need renewed efforts to strangle the industry with progressive sanctions.

The French should get serious and lead the way.