SMOKING AND CANCER: GOVERNMENT AND ECONOMICSWhat cannot be done by individuals and educators may in some measure be done by governments. We cannot advocate that tobacco should be made illegal. Experience from the prohibition of alcohol in the United States in the 1920s suggests that prohibition of smoking would be costly and futile. Restrictions on advertising and increased taxation to gradually price cigarettes out of the market would be more logical. The trend towards the prohibition of smoking in public vehicles and public buildings should certainly be encouraged. Smokers may grumble as the territory for their habit is reduced and may perhaps understandably, react in a defiant way if prohibitions are introduced to the accompaniment of hectoring comments on their filthy, dangerous and self-destructive habit, but they usually adapt fairly quickly to me fact that a particular setting can no longer be associated with smoking.There are many factors which work against the effective reduction in cigarette smoking. A good example of one such factor was given in a study recently published by Dr Warner and colleagues from the United States in the New England Journal of Medicine. They analysed ‘cigarette advertising and magazine coverage of the hazards of smoking’. They found strong evidence that magazines that carried cigarette advertising tended to have fewer articles on the hazards of smoking. This was particularly true for magazines directed at women. This shows very starkly how uncontrolled cigarette advertising can not only have the direct effect of reducing the likelihood of people stopping smoking but can also indirectly inhibit the spread of knowledge about the hazards of smoking.Although in northern European countries there is an identified downward trend in smoking, particularly among professionals, this is much test marked in the southern European countries. In I985, 64 per cent of Spanish physicians smoked and one third of these said they did not consider it of any importance to set a good example to their patients. In the United Kingdom doctors and teachers are not doing badly but nurses have not done well at all and were in fact increasing their rate of smoking until very recently.In 1992, the Department of Health in the United Kingdom produced a document called ‘The Health of the Nation. It included as an objective the reduction of death and ill health from cancers and acknowledged that tobacco use accounted for around 30 per cent of all cancer deaths. Those who produced this policy on health acknowledged that a reduction in smoking would depend on a number of measures, including health education, health promotion, new policies in the workplace and controls on advertising.Currently, some 33 per cent of men and 30 per cent of women in the United Kingdom smoke cigarettes. The number is falling and is predicted to be of the order of 25 per cent by the year 2000. The new health policies include a commitment to try to reduce the proportion of people who smoke cigarettes to 22 per cent of men and 21 per cent of women by the year 2000. If even this modest goal can be achieved there should be a major impact on lung cancer deaths and the many other tobacco-related cancers.More powerful and pervasive economic forces are also at work. The case against smoking is overwhelmingly strong and a large reduction in mortality from many important cancers would be brought about if we could eradicate the habit of smoking within the European Community. The health departments of the member countries are active on the anti-smoking front and the Europe against Cancer campaign has been particularly energetic in organizing campaigns against smoking. There are many reasons why such campaigns are not having a dramatic impact, and we have already touched on some of these.*120\194\4*

How do we go about finding the cause for such symptoms? There are two essential, basic steps. First, we have to find some of actually seeing the source of the problem. Second, if it looks at all suspicious of cancer, we have to obtain a specimen to be examined under the microscope. A word that is often used in tHerring to the trouble spot is lesion. This is a general word winch covers any abnormality, not just cancer. Because it is so Ui-neral it is a useful word to use when we don’t know exactly what the problem is.

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