To mark World Lung Cancer Day on August 1st, Cancer Network spoke with Dr. Alan Blum, Professor and Gerald Leon Wallace, MD, Endowed Chair of Family Medicine at the University of Alabama School of Medicine, where he also directs the University’s Center for the Study of Tobacco and Society, which he founded in 1999. Dr. Blum is an expert on the history of tobacco use, tobacco industry marketing, and the anti-smoking movement. He is a renowned pioneer in creative physician-led public advocacy initiatives to counter the promotion of unhealthy products and lethal lifestyles.
—Interviewed by Anna Azvolinsky
Cancer Network: You’ve studied the marketing tactics used by the tobacco industry to target consumers for a long time [over four decades]—and have organized clinicians to promote health among patients, to prevent [young people] from taking up smoking [and to help them] get off it. Can you talk about some of your recent efforts against smoking and the tobacco industry?
Dr. Blum: Here we are on World Lung Cancer Day, and it is sort of a bittersweet moment in that we have to have a day like this. In fact, I don't understand why we don’t have 364 days for this and maybe give the tobacco industry 1 day a year to blow smoke. It is truly astounding that we need a day to raise awareness of the leading cause of cancer deaths.
I don’t know what to say more than that our medical profession, our oncology societies, our pharmaceutical companies, our insurance companies, [and] our hospitals have not [done] a sufficient job in ending this terrible pandemic. We have pretty much ceded the battlefield to the tobacco industry.
Cigarette advertising has been out of sight for really the past 20 years, since a master settlement agreement in the United States was signed to end cigarette billboards and, for all practical purposes, to remove tobacco advertising from television and from the sponsorship of sports [events].
However, the industry has maintained its grasp on the next generation: There is still internet [-based] promotion, supposedly to those over 21 years old, and there are bar nights and all sorts of clever gimmicks in the Far East and in Central and Eastern Europe, where lung cancer is still extremely prevalent.
Our complacency in the United States is the most important concern that I have. We have Stand Up 2 Cancer, which purports to be working toward a cure for everything, but some of its leading sponsors include those that are still part of the cigarette fuel chain, or the cigarette supply chain, you might say.
Siemens, for example, makes a great deal of the laboratory equipment that we use, but still makes the fastest cigarette-making machines in the world. Then there is Condé Nast (the publisher of The New Yorker), which still has cigarette advertisements in Vanity Fair and other [of its] magazines. There are [also] examples [of companies] like Safeway supermarkets, which still sells cigarettes [and] are sponsors of Stand Up 2 Cancer.
We need to stop the hypocrisy, at the very least. Our own pension funds (such as TIAA) are investing in tobacco stocks. Every university I know has an endowment that is still invested in tobacco stocks. So, you could say that we have met the enemy and he is us; it’s not just the tobacco industry.
Cancer Network: As a clinician, what techniques have you found to be particularly effective in helping your patients stop smoking and preventing them from relapsing? I imagine that the process is very individualized.
Dr. Blum: The issue of smoking cessation has not greatly advanced. We’ve known for a long time that the best way [to stop—I don’t use the negative word ”quit”] is to go cold turkey. In the 1970s, we knew that even a few extra words and personal attention on the part of a physician meant more than just about anything; it improved the cessation rate by 5% [per year] just by saying, “[I care about you and really want you to please] consider this.”
[It would be helpful] if every oncologist who works with a lung cancer patient can also look around and talk to family members and say, “Although we don’t have a foolproof cure for lung cancer yet, we can prevent this, as upwards of 90% of lung cancer is entirely preventable—so I am sure that your dad or your mom would want you to stop smoking and never have any of your children smoke.”
Those are the things that are probably going to do more to immunize the next generation than all of the “Opdivos” and “Keytrudas” that we have [that claim in ubiquitous TV ads to] extend the life of a patient with lung cancer.
If you break down smoking cessation, one of the problems is that medical schools do not teach this. They talk about asking patients [about “quitting”] and “assisting” them and “arranging for follow-up,” but they don’t really look at the words and don’t even ask what brand of cigarettes their patients buy.
I think every physician needs to know what brand of cigarettes their patient buys, because that tells you a lot—if they are buying a budget brand, or whether they think they are getting a benefit from menthol, which is just an anesthetic that deadens the throat. Or whether the patient is buying a cigarette with a filter. No physician asks, “Why do you buy cigarettes with a filter?” Patients assume that since 99% of cigarettes have filters, those must be safer, but that is just not true.
The filter is probably the leading myth that physicians can explode. Filters actually make you inhale more deeply and probably more frequently, to compensate for having to get the nicotine through that filter. That is quite a striking myth that physicians can debunk for their patients.