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David Katz, M.D. Headshot

A Thousand Words of Warning Against Tobacco

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There simply isn't room on a pack of cigarettes for a thousand words of warning. Certainly, tobacco deserves that many admonishments, and more. We have known since 1993 at least that tobacco use is, quite simply, the leading cause of premature death in our society.

We have made progress against tobacco use over the past two decades, but that simple, summative expression of its toll remains true thus far. With a certain advance against tobacco use, and rampant obesity, we are likely to see the combination of eating poorly and lack of physical activity overtake tobacco as the leading cause of premature death and chronic disease. But even if that occurs, tobacco will remain fixed among the top three causes -- at best.

To change that, we need a mechanism to lower tobacco use further. It is fixed at roughly 20-25 percent of the population. Good relative to historical high points, but still, in a word, dreadful. One in four Americans still routinely places a lung-ravaging, cancer-causing cylinder between their lips and sets fire to it multiple times a day.

And worse still, nearly 4,000 teens and pre-teens around the country try cigarettes for the first time every day. For one in four of them, this will turn into a lifelong addiction.

And so we come to the thousand words. The U.S. Department of Health and Human Services recently announced that it is going graphic. With oversight by the FDA, cigarette packs will sport warning images rather than just words. The intent is to provide the curious adolescent a sufficiently jolting dose of reality at the moment of decision -- that they think better of the whole thing, and walk away.

Maybe that will happen if we were right all along and a picture is truly worth a thousand words. A thousand words of warning against tobacco doesn't seem nearly enough to those of us who have cared for its victims over the years.

Tobacco is a public health scourge that deserves nothing less than outright banishment from our society. I can picture a day when we look back on smoking as a tragic, but historical folly. Here's hoping pictures help get us to that day sooner than later.

-Dr. David L. Katz