What Obesity and Nicotine Addiction Do Have in Common

Ok, this post is not about comparing overeating to smoking. It is also not about borrowing obesity prevention or management policies from tobacco. And it is most definitely not about even suggesting for a moment that obesity solutions are even remotely related to the way we have dealt with with smoking by making it socially unacceptable, inconvenient, or unaffordable.

This post is about something very different. It is about how, in my experience, many “obesity deniers” often use the very same strategies and arguments used by ‘Big Tobacco’ to discredit even the suggestion that there may be an obesity epidemic out there and that, even if it did exist, it has any impact on population health.

These strategies, that could have been directly gleaned from Big Tobacco, include the following:

1) All scientific studies are flawed and inconclusive – associations do not prove causality.

This is a very common strategy used by interest groups to discredit any unwelcome research findings. Thus, despite experimental proof of carcinogenicity (biologic plausibility) and overwhelmingly consistent associations between smoking and health risks (coherence of data), critics and activists argue away all such evidence with the following tactics:

a) findings in animal studies or cell culture cannot be extrapolated to humans.

b) smokers have poor health not because they smoke but because they also don’t exercise, eat poorly, lead stressful lives, are risk takers, have lower socioeconomic status, etc, etc, etc.

Indeed, anyone even suggesting that tobacco may be unhealthy and smoking cessation may be a good idea is accused of not understanding the literature, jumping to conclusions, ulterior motives, promoting the nanny state, inability to see the big picture, being a ‘health nazi’, and countless other ‘personal’ accusations (if you can’t discredit the science, you can always discredit the scientist).

2) Present anecdotal evidence and personal stories and testimonials:

These arguments fall along the lines of pointing to people who smoked all their lives and died after falling out of bed at age 104 or the fact that most people who die of heart attacks, strokes or cancer never smoked a cigarette in their lives. I have heard the quote, “you only have to look at me to see that smoking does not kill people”.

3) The need for nicotine is a ‘natural’ condition

Here the argument is that some people (not everyone, but many) are genetically (or otherwise) predisposed to addictions and that for them smoking is simply a natural way of dealing with this ‘condition’ – in fact they will point out out that smoking is perhaps one of the lesser of the many evils that such people could turn to, so trying to get people to stop smoking would simply be driving them to overeat, drink or use illicit drugs and can even result in severe depression or suicide.

Very closely related to this ‘tactic’ is the statement that tobacco cannot really be all that harmful, as it has always been around, has been part of traditional ceremonies, and serves an important social function. This also implies that ‘medicalisation’ of smoking is simply Big Pharma wanting to sell you smoking cessation pills, gums or patches (with all of their risks and side effects) or doctors wanting to make money with smoking cessations programs.

4) Trying to get people to stop smoking is pointless because recidivism is so high and there are so many negative consequences of actually quitting.

According to this line of argument, because quitting is tough, risk of relapse is high, and negative consequences (see above) cannot be ruled out, it is perhaps better to simply let smokers smoke and focus more on helping them improve other aspects of their lifestyles – better to be a healthy smoker than an unhealthy non-smoker!

I have long given up even arguing about this issue with ‘deniers’ because I never sense that I am dealing with people, who are even open to discussion. No amount of data or arguing will change strongly held beliefs and convictions, so it is pretty much a waste of time trying to expect rational discourse.

Fortunately, I can generally chose to ignore this issue, because I find it a far better use of my time to help those, who actually want and value my advice. Those, who believe my advice is wrong or misguided, are more than welcome to ignore it.

I have never approached medicine with the goal to change the world – my goal has always been to understand what each of my patients wants and give them the best advice I can, based on my understanding of their needs, issues, and circumstances and on my experience and knowledge of the science and art of medicine.

In the end everyone is welcome to take it or leave it, like it or not – I learnt a long time ago to never take rejection or opposition from patients personally.

On the other hand, I do love a serious discussion – i.e. one where the discussants do not have firmly held beliefs, unchangeable ideologies, or axes to grind – all other discussions, are largely a waste of time.

When evidence changes, I change my opinion – I am never locked into any view or opinion for any reason other than what my knowledge or understanding of a topic convinces me is current best knowledge.

I am happy living with uncertainty and ambivalence – I will be the first to admit that I do not have all the answers.

Indeed, having all the answers would be pretty boring. As I;ve said, before, I certainly prefer the uncertainly of knowledge to the certainty of ignorance.

AMS
Ottawa, Ontario