I went to a government public school in Trichur in Kerala. There the boys start smoking early. My friend and classmate Anees Ibrahim started in the sixth standard. I don’t know where he got the money to get cigarettes and beedis from, but he was smoking all the time. Whenever the teacher was not in class. During recess. Sometimes he cut classes and chain smoked. After I finished school, he had apparently continued smoking. When I started college, he was working with his father at his shop. When I was around twenty, someone informed me that Anees had died. He complained of a sudden chest pain and died on the way to the hospital.
‘No one knows how he died. He was so young; it couldn’t be a heart attack.’ He told me.
But it probably was.
Five thousand years ago, or maybe it was seven thousand, a group of humans in South America learned to cultivate a plant to harvest its leaves. The leaves they burnt, and inhaled the fumes, and found it pleasant for some reason. They considered it a special gift from the creator, healthful and invigorating. The exhaled fumes carried their prayers straight to the good god above, or so they believed.
The plant was tobacco.
After colonisation, the plant was carried and re-planted lovingly by humans. It reached all the corners of the globe, leaving the local people puffing away at it’s fumes for all they were worth. It was generally considered benign and even life-enhancing. Throughout the industrial revolution and the budding age of reason, Europeans burned and inhaled tons and tons of the dried leaf.
Doctors considered themselves men of science in Europe from the seventeenth century onwards. Throughout the seventeenth, eighteenth and nineteenth centuries these men of science praised tobacco and smoking for it’s health enhancing properties. And they puffed away at pipes, cigars, cigarettes, etc, happily while seeing patients and when they performed surgeries.
It was first in 1929 that a German doctor named Fritz Lickint found a statistical association between smoking and lung cancer. But it was ignored by most of the world after Germany’s defeat in the Second World War. In 1954 a study of forty thousand British doctors over twenty years found a clear link between smoking and lung cancer. Then the world started paying attention.
Today we know that smoking is a major risk factor in causing:
Heart attacks, strokes, emphysema, and cancers of the lung, larynx, mouth, oesophagus and pancreas. It is the number one cause of bladder cancer. It causes diffuse narrowing of blood vessels throughout the body that causes gangrene leading to requirement of amputation of foot and leg.
WHO estimates that tobacco causes more than five million deaths a year. The US Centre for Disease Control describes tobacco as the single most important preventable risk to human health in developed countries.
In its five thousand history of rampant use, not once was the devastating nature of this drug found out by healers, rulers and philosophers, till the systematic studies of the twentieth century. No one was wise enough.
This story is a lesson. Common sense is not an accurate way of getting at the truth in Medicine and Public health. Sceptical Science is the way. Any supposed truth can be questioned. Anyone can try to falsify any axiom of Medicine by scientific means. Doctrines that survive will have a core of truth. But there is no point in bringing in dubious conspiracy theories, faith and pseudo science into the mix.