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A direct, small scale approach to keep people from smoking
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A good number of years ago, I lost my patience while treating what appeared to be an endless stream of lung cancer patients. After watching one patient after another fight a losing battle with lung cancer, I was brought to the point of exasperation by a 43-year-old female accountant. She had developed lung cancer after inhaling second-hand smoke. Unlike the rest of the lung cancer victims who had “brought it on themselves,” she was an innocent bystander. No matter that the advice of some of the best minds in medicine had been ignored by the smoking lobby and their addicted victims, I decided I would try my own tack, on a small scale, to “get the word out.”
I decided to take a direct approach. If young people were being told by their peers and the tobacco companies that it was cool to smoke, then I would go to them in our local high school and tell them otherwise. I contacted the local high school principal and asked permission to give a class in health issues about smoking and lung cancer. I asked my accountant patient to accompany me to the school and be interviewed by the students. By this time, she was already wheelchair-bound secondary to bone metastasis but agreed to come. I brought her radiographs with me to show the students (We were using film at the time).
Two sides of the story
I was skeptical of the potential student and teacher responses. I was seated, feeling very out of place, waiting for the students to file into the classroom. Some of the students might have known me, since my oncology practice is in the community, and I might have treated their relatives. Some might have known my wife as their pediatrician. Some might have known us directly, since we practice where we live and our children might have gone to school with them.
The students took their seats, some slouching in typical teenage posture, making it easier to conceal their true feelings about my presentation or its subject. I presented the patient’s history, described her clinical course, projected her outcome, and showed them her radiographs. They were absolutely silent. Then I asked for the patient to come in. Although it might have been difficult for the students to fully identify with a 43-year-old patient, they seemed to understand where she and I were coming from.
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They spoke with her and questioned her directly. After the patient left the room, the students asked me a few questions, and the class was over. The presentation had gone well. The principal asked me to stay for a second group of students.
Did it make a difference?
I have often wondered whether this confrontation method is effective or not in helping young people to stop smoking or discouraging them from taking up the habit. Many years later, I asked the former principal, who is now my myeloma patient, her thoughts about the class. She remembered it vividly and wrote the following paragraphs for me to include in this article.
“During the late 1990s, when I was the principal of OT High School, I had the privilege of observing an extraordinary lesson in one of my school’s science classrooms. The lesson, which focused upon the health issues and dangers associated with smoking, was presented by two guest speakers — oncologist Dr. Arthur Topilow and one of his patients. The patient, who had been exposed to second-hand smoke and was being treated for lung cancer, wanted to speak out about her own struggle with this deadly disease in an effort to deter teenagers from smoking.”
The first part of the double-lab period was conducted by Dr. Topilow, who discussed factual scientific and medical information about the effects of smoking cigarettes on the human body. His presentation was extremely interesting, informative, and learner-friendly. The students were respectful, attentive, responsive, and very much involved in the lesson and the discussion. Both Dr. Topilow’s lecture/discussion and that of his patient, which followed, were excellent examples of how real-life lessons and appropriate guest speakers from the community can do so much to enhance student learning, especially in specialized areas such as medical science. It certainly helped that Dr. Topilow’s personality and style enabled him to fit perfectly into a high school setting. The students were much impressed with him as a prominent physician and as a compassionate human being. I shared their enthusiasm.”
The compliments were flattering, but I never did find out if the approach had been worthwhile for that particular set of students. It is well-known that a multifaceted approach, which includes behavioral modification and pharmacotherapy, is often needed to get people of any age to stop smoking. Unfortunately, refraining from smoking and smoking cessation will remain big problems for the foreseeable future.
Arthur Topilow, MD, FACP, is Director of the Section of Hematology/Medical Oncology at Jersey Shore University Medical Center and maintains a private practice at Atlantic Hematology & Oncology in Manasquan, N.J.