Doctor dares to criticize tobacco control

CBC reports in Smoking Defended by Quebec Doctor (link to article here) that psychiatrist Jean-Jacques Borque is of the opinion that smoking can be a comfort to the deeply depressed, that the dangers of second hand smoke are overblown and that smokers are under an unreasonable amount of pressure to quit.

What is most illustrative about this is not the fairly conservative statements of the doctor but the responses to those statements. If he would have said that second hand smoke could kill you within 15 minutes, that warning labels on cigarette packages should actually be larger than the packs themselves or that smokers need to be locked out of government jobs to force them to quit, this would have passed with little comment.

But if you wander through the comments on the article you find the righteous rage of the anti-tobacco extremist at the person who dares to question the prevailing political correctness. Most of the comments suggest that his opinions could only be held by someone in the pay of the tobacco companies or by a smoker. (It seems that being a smoker instantly disqualifies you from being able to think independently on these issues and somehow being a nonsmoker gives you a special insight into why people smoke….of course, neither being the case).

For some reason, being a psychiatrist and having first hand knowledge of the effects of depression, and of smoking in that context, counts for nothing. And of course, were he to offer the opposing opinion, his status would suddenly become relevant.

The knee jerk reactions to this honest position seems to come from that well entrenched tobacco control idea that smoking has no conceivable benefits. People only smoke because they do not know any better or that they don’t care. Everybody who smokes, hates it and wants to quit.

The point is that any behavior, even one with so many negative effects as smoking, has to be considered within a context. All other things being equal, it is better not to smoke. But if you are deeply depressed, the depression could affect your health in many ways including an increased risk of suicide, and if you find relief in smoking, what you are doing is balancing an immediate and certain danger against a future potential danger. It then makes all the sense in the world to smoke.

As I have written previously, ironically, for us in tobacco harm reduction, a hard line against smoking would seem supportive of our position. After all, we are trying to get people to adopt safer alternatives. But also ironically, our greatest foes in reducing the risks to smokers are those same hardliners in tobacco control and in positions of authority in many health departments.

Ultimately, health initiatives work best when politics are not part of the equation. Vilifying smokers, smoking and tobacco only preserves the status quo and keeps us locked in this impoverished quit or die mode.


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