 |
| ASSEMBLY EDITION • ORLANDO, FLA |
There are 500 million people alive today who will die tobacco-related deaths.Thus began the presentation Wednesday at Wonca 2004 by Sean David, M.D., assistant professor of family medicine at Brown Medical School in Providence, R.I.
The 500 million is "equivalent to all the deaths in the Vietnam War occurring every single day for 25 years," said David.
"And if anyone were kind enough to build a memorial to those who will die a tobacco death in the first half of this century, and patterned it after the well-known Vietnam Memorial, it would start in Washington, D.C., travel west for six states, 1,100 miles, and end in Kansas City."
"Some of the names on that wall would be your patients. And, if you smoke, some of the names on that wall would be yours," he told attendees. "With all due respect to AIDS, malaria and other infectious diseases, tobacco is the greatest public health menace in the world today."
The message was well-targeted to the audience. After all, at the last Wonca world conference in 2001, the Wonca Executive Committee declared its "Call to Action on Tobacco Cessation" to encourage a global effort against the tobacco scourge.
David made the argument for the cigarette as a drug-delivery device: "When nicotine reaches the brain, in less than 10 seconds, it leads to release of dopamine and serotonin in the nucleus accumbens, resulting in pleasure and, later, to the relief of nicotine withdrawal. When smokers are hooked, the nucleus accumbens becomes activated by cues in the environment such as the pictures of people smoking in cigarette ads."
David told attendees about his own research studying genetic influences on nicotine addiction using functional magnetic resonance imaging and positron emission tomography.
In addition, he is studying how genetics influences smoking cessation with nicotine replacement therapy and bupropion in three randomized clinical trials. "Namely, we wish to know whether genotype will affect the response to drugs like nicotine replacement and bupropion on the behavioral phenotype of smoking cessation," he said.
"You may be thinking, 'our patients are doomed,'" he said. "They are biologically vulnerable to smoking and hooked on the most addictive substance known to man. But, thankfully, that is not where the story ends."
Environmental factors play a major role in why people smoke. This is why policy interventions can have a major impact on preventing tobacco-related deaths, he told the Wonca attendees, encouraging them to bring their influence to bear on the powers that be.
"We're at the crossroads of the greatest public-health crisis of our time," he said. "We can win this war."
FP Report is
published by the AAFP News Department.
Copyright © 2003 by American Academy of Family Physicians.