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)
