For decades, Hollywood gave the tobacco industry the best and most seductive
advertising that any product could hope for. In recent times, the film
industry has been trying desperately to atone. The most striking instance of
movie-as-anti-smoking-ad is Kenneth Branagh’s 1991 film noir Dead Again.
The movie switches between the 1940s and the 1980s. Andy Garcia plays a
smooth, chain-smoking, Bog-art-style detective. We see the same character 40
years later, facing terminal cancer in a hospice. Branagh’s character visits
him in the home and lights a cigarette. Garcia asks for a drag, pulls down
his elegant silk scarf, unplugs the surgical stop in his neck, puts the
cigarette to the hole and inhales. Garcia hands back the cigarette, but
Branagh refuses, saying: “Thanks, I’ve just given up.”
For years I thought that was a typical piece of modern movie-making, at once
melodramatic and right-on. Now I know it’s closer to documentary, based on
the real experiences of people dying of diseases associated with smoking.
Put glibly, they don’t give up easily.
My brother Glyn smoked throughout his 14-month fight against laryngeal cancer.
Glyn wore a surgical bib to cover his stoma, and would cover the air vent to
allow him to smoke and talk. The sight wasn’t as shocking as the Dead Again
scene, but it was certainly disconcerting for strangers.
In March, Glyn, his wife and two of his children came down from the Midlands
to stay with me in London. We had a lively night at a riverside pub in
Greenwich and my brother asked for a light from some blokes in rugby shirts.
Glyn, absolutely in his element (the pub), lit up, turned his chair around
and got talking about the day’s international matches. The rugby fans were
cautiously matey but visibly disturbed; here was a bloke with a bib and no
hair, clearly suffering from throat cancer, acting like nothing in the world
was the matter.
Perhaps they were expecting an evangelical antismoking lecture, like the
surfers suffering from skin cancer who used to tour the beaches of Australia
talking about sun protection. They needn’t have worried. Lecturing, being
evangelical and saying anything remotely antismoking were three things my
brother never once did in his 53 years.
By that time, the cancer was terminal, so no one was going to deny him one of
the fast-dwindling number of physical pleasures. But it was a different
picture six months earlier during another visit to London, when the tumour
appeared to be responding to radiotherapy. Then, there were no signs of
secondaries and the medics were doing a good job keeping our spirits up.
That’s when Glyn’s smoking really bothered me. “I know, I know,” he said, as
he lit up on the terrace of my flat. “Don’t tell Mum and Dad.”
It was a troubling moment, hearing my middle-aged older brother talk like a
furtive teenager; more troubling still to be asked to be his accomplice in
keeping the fact that he was still smoking “secret”. I can’t remember
exactly what I said – something about him being bloody stupid, surely he
could see it couldn’t do his chances of making a full recovery any good,
etc. (It wasn’t as if he was incapable of giving up – he had, for 12 years,
before the stress of his divorce lured him back to the Marlboro Reds.) But
he didn’t want to stop; and here is a situation that thousands of people
must face when they are confronted with a relative or a friend in the grip
of an addiction. They’ll go on doing what they are doing whatever you say.
They’ll just do it behind your back, and it may mean they avoid seeing you;
and when time is short and precious, that’s the last thing you want.
So I sought advicefrom the various cancer charities. The Cancer-backup
helpline said that carrying on smoking is “an individual’s decision” (which
is undeniably true), “but, if smoking caused the problem already, they can
only benefit from giving up to give the immune system the best possible
chance”. Glyn and his second wife Carol (who, loyally, also carried on
smoking) had meanwhile been advised by his consultant that, now the tumour
existed, continued smoking couldn’t make it worse; and that in any case it
was rare for smoking to be the cause of his type of laryngeal cancer. So
that was a green light for the Marlboro Reds.
I’ve since checked with Cancer Research UK and it confirms that there is no
evidence that smoking has any effect on the treatment. But it makes the
immune system argument too: that while you’re battling cancer you need to
bring your risk level down to zero, which means a proper diet, exercise and
cutting out the fags.
By November, all this was academic. The days of cheerful defiance came to an
abrupt end: the tumour had returned and the cancer spread to the lungs. That
was it: we were into that most euphemistic of stages in cancer treatment,
palliative care.
Glyn never did his immune system many favours. He drank hugely, ate badly,
never exercised. Whether the Marlboro Reds played a big role in his illness
or not, for me they were a powerful symbol of what we now call the
“lifestyle factors” that override our genetic predisposition towards the
disease. I didn’t like cigarettes before; now I hated them as I’d never
hated anything before. I couldn’t look at the smoking groups congregating by
the car park entrance and found it hard to deal with them normally at work.
The symbolism for Glyn couldn’t have been more different. Smoking meant
normality, carrying on, not being browbeaten by the illness. It was, I
think, a mate at a strange and difficult time.
Some smokers turn violently against the weed when they become ill. I read an
interview with one Derbyshire man who smoked for 50 years but after his
diagnosis could not get into a taxi if he smelt smoke. At the other extreme
is the aged rocker Ronnie “the Hawk” Hawkins, who was given seven months to
live when diagnosed with pancreatic cancer. “So I doubled up – no, tripled
up – on everything,” he said. “Whisky, drugs, cigarettes.” After a few
months a CAT scan revealed his cancer was gone. “Them germs are afraid to
get into my body. I knew that eventually they’d have to get out. They
couldn’t take it.”
Glyn didn’t quite go the whole rock’n’roll hog, but his attitude had something
Hawkish about it. He focused on getting down the pub, meeting his friends,
carrying on. He didn’t whinge, blame anyone – not even himself – or
anything, including the cigarettes. This raises the interesting question of
etiquette among the families of cancer victims. If the cancer patient
refuses to rage, blame and point fingers, you can hardly do so too.
Still, his life was drawing to an end as the smoking ban came in and no
journalist can resist a coincidence like that. I asked him: 30 years younger
– would he have given up? A headline came irresistibly into my head: Could
the Nanny State have Saved my Brother? I don’t know what reaction I
expected, but I didn’t get one. Glyn didn’t go in for whys and what-ifs; and
maybe that’s as powerful a form of palliative care as any – albeit one that
few of us facing a premature death could ever adopt.
But the sales are falling – 7 per cent since the public smoking ban – and the
tobacco marketing men have a fight on their hands if they’re to find and
keep a new generation of people such as Glyn. Jim Scully, the senior
vice-president for brand-building at Philip Morris and the man responsible
for marketing Marlboro cigarettes in Europe, said recently: “We are not
sitting back on our laurels. We are embracing the fact that we have to
change.” And while Scully is not complacent, neither is he panicking at
signs of decline in his most famous brand. He has one great asset on his
side.
“The passion and loyalty of our smokers,” he said, “is amazing.”
At lunchtime on July 31, Glyn went into the garden at his house in
Leicestershire, and smoked a Marlboro. Afterwards, he went back to the
living room for a sleep. The sleep became a coma and he died at about 8pm.
He was 53 and left a wife and three children. He had smoked Marlboro Reds
for more than 30 years.
Throughout his 14 months of cancer treatment, he had carried on smoking
whenever he could, through the radiotherapy, through the chemo, through the
last months when he was too tired even to go to the pub. His passion and
commitment had indeed been amazing.
Never going to give you up: why ill smokers stay committed
One thing that we humans do very well is to defend ourselves psychologically,
and our most potent weapon is denial. But when confronted with a terminal
disease, denial flies out of the window. We have to find another defence.
If we are smokers, and lung or throat cancer is diagnosed, denial is replaced
with a sense of shame and/or guilt. Often, respiratory physicians are not as
understanding as they might be and society stigmatises lung cancer by
insinuating that it is self-inflicted.
The obvious defence mechanism in these situations is self-justification. For
many, smoking after being told that they have a life-threatening illness is
their way of saying: “I did it my way, I don’t regret it and I am still in
control.” If the smoker needs to feel in charge, this way of thinking can
even be healthy. However, it is important to get the right balance. Smoking,
even in the short term, decreases the quality of life significantly. It
affects the ability to fight infection and results in a psychological
rollercoaster, because of the seesaw of withdrawal symptoms and sense of
release. And although quitting smoking will not always reverse the
prognosis, in many cases it can do.
Although the psychological battle to give up seems different after a terminal
illness is diagnosed, essentially the principles are the same. Something is
causing you to smoke, and that is nicotine, and nicotine addiction.
The steps towards giving up are therefore the same for everyone. Consult your
GP, use the NHS counsellors and lean on support from groups such as Cancer
Research UK (cancerresearchuk.org) and Quit (www.quit.org.uk
).
— Professor Robert West (The author is director of tobacco studies at
Cancer Research UK)
I spent a day with my cousin on Saturday cleaning her new house, which had been lived in previously by an elderly smoker. Seeing the discolouration of "white" walls, uPVC window frames and even venetian blinds, together with the strong stench from carpets and curtains made me ponder on the terrible damage which must occur internally to body organs if this is what occurred on the outside!! Thankfully I have never smoked, having grown up hearing my mother and brother rasping and coughing - "dying" for their first cigarette of the day to "clear their throats". I welcome the smoking ban wholeheartedly, for everyone's sake.
Phyllis, Brentwood, Essex
I'm 31 and have been 'giving up' smoking for about a year now. This article, and indeed many of the comments that follow, has been the impetus I needed to finally free myself from the illusion that I enjoy, or need, to smoke.
I don't have children but would like to in the next few years. Mark Jones' brother Glyn was 53 when he died - at that age my children will probably still be teenagers, and I just can't do that to them.
I couldn't do it for my parents, or for my boyfriend (which I hate myself for) but I will do it for my unborn children.
Thank you, Mark.
Sarah Robinson, London,
i smoked for over 40 years, i quit recently and am amazed at how much my breathing has improved, whenever i am tempted to have a cigarette i remember how i used to fight for breath in the mornings and it makes it very easy to resist temptation
j whale, billericay, england
My father died on 20th July of cancer of the larynx and its spread into his bones and lungs;he was a lifetime addict to nicotine and vehement denial of its undoubted and visible effect to his health continually perplexed and at times angered me.My mother gave up smoking for the last 7 months of his illness but following his most agonising death has bizarrely taken it up again. I have always found the habit revolting and repulsive ;the fetid stale scent of tobacco permeates not only the smokers lungs but also their breathe ,skin, clothes and home. My mother's minimum 2 pack-a-day habit will cost her £3,650. annually;luxury holidays,clothes, cars what fun could be afforded but for addiction to a stick. LIfe is about experiences ; they missed out on many. Smokers argue it is their freedom of choice to smoke; may I then use the same argument to be free of responsibility to the smoker when ill?The premature and painful loss of one parent to nicotine has exhausted my patience and empathy.
Fiona Cater, London,
My god, I had no idea that smoking cigarettes was dangerous and could cause all kinds of illness. What else are they not telling us about some of the daily pleasures we take for granted. They will be telling me next that my 5 pints a night is bad for me. Where will it all end I tell you, where will it all end?
D Nial, Coughington, USA
OK. So he lived unhealthily - as we all must do to some extent, to avoid the grotesque morbid state of a completely safe and healthy lifestyle - and then he died in a way which may have been connected to, but was by no means a certain result of, behaving in a somewhat unhealthy way; but it could have just been random chance; and while this was happening you developed the opinion that he overdid it. Mmm.
I liked the parts where you cast doubt on whether he was compelled to smoke by addiction and whether it was smoking that killed him. Those parts were interesting.
Felix, Nottingham,
Good article, but just to say that the film industry has hardly given up. Many films are showing the stars smoking.
ray rasmussen, Edmonton, Canada
I lost both of my parents to illnesses caused by their smoking. And it seems to me that with around 125000 people dying prematurely this way in Britain every year, it is surprising how little discussed the effect this has on families and loved ones is. When one things about it, the scale of this completely unnecessary human tragedy is overwhelming. Why do we put up with it? Why aren't those responsible banged up for their crimes? Why on earth do we let them get away with it? Shame on us.
Anna, Cambridge, UK
That was an excellent aricle. I could relate to it appreciatively. I smoked more thanhalf of my lifetime before a blessing in disguise occurred. A angina attack and a doctor disdainfully telling me to give up the weed. So it took a frightening icident to occur and someone telling me to stop, otherwise I would have gone on as I obviously could not do it on my own.
Peter Wasilenko, Yonkers, New York, USA
What really amzes me is how the Government can continue to allow cigarettes to be sold openly and take taxes from them ,whilst all the while knowing full well then they are killing people as well as costing the NHS many hundreds of millions, if not billions, of £ each year. In my book that makes the Government know better than a drug dealer, as there is no difference except that the Government decided to make an exception for tobacco because it pays well. I also wonder when the first claim/class action will be taken against the Government for such negligent failures to protect/implicitly promoting tobacco and/or assisting in knowingly selling a dangerous drug ??. Why no action against them as yet I wonder ?
Kevin , London, UK
In response to Brian vallance: yes, the medics may well give you opiates as pain relief whe terminally ill. But they don't give it to you 20,30,40 times a day when you are fit and well. Using that anology is bad taste & slating prof West in poor taste too. He actually said that some physicians aren't as understanding as they could be when dealing with "self inflicted illnesses". Do you work for the tobacco industry Brian???
Emma Broadbent, Salford,
I agree wholeheartedly with Donald Smith, London. Allen Carr's Easyway to stop smoking is the best way to beat the "addiction" of nicotine. I just love it when non - smokers bang on about "self- inflicted". Yep smokers chose to light up in the first place but unless the sanctimonius idiots read the facts about addiction they have no idea what they are talking about. Just remember it just takes one puff! They should be saying "there for the grace of god..." There are many reasons why people smoke in the first place, and not because people are necessarily idiots!
JJ, Auckland, New Zealand
A sincere article really, though a question arose in mind is Was it a case of self destruction aided by nicotine?
kk, Columbus, Indiana
Part Two : "Never going to give you up: why ill smokers stay committed"..........What a load of sanctimonious clap-trap.
When you are terminally ill, short of the classic 'walking under a bus', nothing else is going to kill you !! You cannot die twice.
If continuing on as normal helps your well-being, good luck to you - Go ahead. Nobody else's views have any relevance whatsoever (assuming that you are not harming others). The medical profession make us all heroin addicts at the end to relieve pain and suffering. The addiction problems become totally irrelevant in terminal care. (As with nicotine)
Giving up smoking in such circumstances may possibly give you a few more weeks/months of life - but in misery.
The first part of the article was excellent and to be recommended, but the (so called) expert view was callous, cruel and totally un-professional.
Has Prof.West never heard of the Hippocratic Oath?
Brian Vallance, LEFKIMMI, Hellas
"Insuinuating" that cancer is self-inflicted? Get serious! If you smoke, and you have any form of cancer, then you absolutely did inflict it on yourself. We've known for decades that smoking causes cancer, and anyone who chooses this particular mode of suicide shouldn't be treated at the public's expense.
John C. Randolph, Cupertino, California, USA
My experience is very similar. My dad passed away last year after a life spent smoking and the last 15 years of his life spent breathing from an oxygen tank - no lungs anymore.
I have smoked for over 20 years and gave up 3 years ago with the NHS programme and Zyban. I also miss my Marlboro Lights, from time to time and the missing does not last long fortunately, but since I have stopped I feel reborne and proud that I am out and not a slave anymore.
It takes courage, it is not easy but it can be done.
Patrizia, London,
Allen Carr's Easy Way to Stop Smoking does exactly what it says on the packet. I gave up three years ago and haven't thought of smokes since. Carr succinctly explains that smoking is simply a drug addiction and a slow, burning fuse - left alone it will continue to smoulder away, so the fuse must be cut. Smoking merely satisfies the craving for the next cigarette, but provides no benefits other than that, so it is just an illusion of comfort that follows short periods of uncomfortable withdrawal. Smoking gives the impression of enjoyment, but it's a bit like taking an aspirin for a toothache. Cigarettes only provide relief from the discomfort caused by addiction to nicotine. Carr further distills his method in his Easy Way to Control Alcohol which teaches you all you need to know about quitting booze in 181 pages. Again, Carr explains how drinking is just the illusion of enjoyment, but is really just a confidence trick. If you don't believe me, read it and find out for yourself!
Donald smith, London, Uk
AMAZING DISGRACE
What is amazing is that cigarettes are still freely available for sale world wide, despite the fact that
they are universally recognized as a direct cause of various deadly cancers, as well as emphysema.
The power of the tobacco companies is simply amazing...but, of course, "money talks"!
Garth Rex, Glendale Heights, USA
I smoked Marlboro reds paasionately for 15 years. I was an absolute slave to that brand. After deciding to give up 'Zyban' made the actual experience easy. That was nearly ten years ago - I'm still a recovering smoker and I still miss my Marlboros. I think I always will...
Fantastic article. Thank you
Nick Barnes, Cardiff, Wales
My father smoked himself to a horrible, painful, early death, dying from lung cancer at the age of 71. Before the cancer, he had suffered two strokes (the first at age 50), a heart attack, and two difficult arterial surgeries. He was unable to work for most of the last 20 years of his life because of these health issues (he had been a dentist). The strokes altered his mind and left him crippled. He smoked throughout, simply saying, "I like to smoke." His father and both of his elder brothers died before they were 50 of stroke no doubt because of smoking. The addiction is terrifically powerful. It is incredible to me that anyone at any age would start smoking.
Jeanne, paris, france
To be honest I think that expensive medical care such as chema therapy should be withheld from patients who refuse to give up smoking, and treatment given to patients who are prepared to make a bigger effort.
Toll Pinner, Bradford,
Allen Kar's "Easy way to quit smoking" helped me and a dozen of my friends after 7-9 years of smoking. We really apreciate him, just try to read it, it works!
Vitaly, Minsk, Belarus
My husband smoked long and hard for 25 years,averaging 30 a day.He has been without them for 5 years but always says that if he was diagnosed with terminal cancer,he would immediately resume smoking....that is some addiction!
paula galvin, leixlip,co.kildare, ireland
It's so sad and stupid to play into the hands of the tobacco industry.
Gene, Sydney,
Not giving up smoking is called demonstrating "the handicap principle" = it will never happen to me because, look at me; I am an alpha plus and feel fine!. I feel very angry about the inconsiderate sod sitting next to me with "that thing" dangling from his or her mouth. I move away from the smoke, only to see the "sod" come back to blow "that stuff" all over me. A clenched fist does the trick even though I am, then, branded "intolerant".
Simple question. Would you take a five pound note and burn burn one once or twice every day?
By the way; I am very sorry for the families of the smokers and, occasionally, for the suffering of the dying smokers.
Patrick Bagot, Istanbul, TURKEY
A great article. My dad never gave up drinking right up until it killed him. Nice to read such an emotionally in-depth piece of writing. It isn't simple, is it?
Lynn Riordan, Berkeley, California, USA
Hi! My dad's death was also caused by a lungs cancer. He was suffering for two months. It was very hard for him to breathe and because he was scared of death and so tired he couldn't even talk to us, he was trying not to sleep. He stopped with smoking four years before "the end" and 44 years after the first cigarette. And actuallly, the real reason for quitting was a heart sickness. Imagine, how feels someone dying with a heart that's as twice as big as it should be. Imagine how feels a 60 years old man knowing he must leave us (mom, two daughters and a son) two months after his (mine) son's wedding. Smokers from all over the world! Don't let your mortal behaviour kill you!
Tomasz , Radomsko, Poland