Smoking, lung cancer and the ‘sin tax’ bill

A few months ago, a 64-year old business man came to see us with persistent dry cough for more than a month. He just self-medicated, took two different kinds of antibiotics he had taken before, but felt no improvement. He was smoking two packs per day and cut it down to one pack a day when he started having the cough. He swore he was feeling great until this current coughing problem, and didn’t think his smoking was such an issue. He started getting worried though when his phlegm became blood-tinged in the last several days.

Chest X-ray and CT scan of the chest showed what we dread most in smokers when they complain of persistent cough, especially if he’s coughing out blood. He had a tumor in the lungs, highly suggestive of cancer. We referred him to a lung specialist, and further testing including biopsies of lung tissues obtained by bronchoscopy (insertion of an instrument through the windpipe) indicated an aggressive or high-grade type of cancer cells. He had a late-stage lung cancer already which was beyond surgical resection. He was referred to an oncologist for palliative chemotherapy just to prolong his life a little bit and make him comfortable.

No matter how many terminal cases we’ve seen like this, it’s always depressing to see another new case. Lung cancer remains the leading cancer killer worldwide. It’s a sly killer which stealthily sneaks into a person’s system and gradually erodes one’s health. Before the victim realizes it, it’s too late already.

This is the problem with smoking and lung cancer. It takes many years before symptoms appear; and usually they’re attributed to many other things except lung cancer. Smokers generally have a sense of denial, and they always try to belittle the hazardous effects of their sinful vice. They also avoid seeing their doctors because they know what their doctor will tell them—that their medical problem is smoking-related and they have to lick the habit—which they’re not willing to follow.

Curable

Although early-stage lung cancer can still be cured with surgery, more than two-thirds of cases will present with late-stage cancer already, which is beyond surgical resection and cure.

Majority of cases are already in stage 3-4 when diagnosed, and the only goal of treatment is to prevent rapid progression of the disease and improve quality of life by minimizing distressing symptoms as coughing, difficulty or shortness of breath.

Almost every smoker knows that cigarette smoking has been implicated as the primary cause of most types of lung cancer. It has been identified as a contributory factor in 8 to 9 out of 10 cases of diagnosed lung cancer. Yet, many still smoke. That shows how powerful the addicting power of nicotine is—it makes one think irrationally already of what’s good and bad for one’s health.

This makes it also difficult and disheartening for doctors, other health professionals and health advocates. If one sees someone trying to commit suicide by jumping from a building or shooting himself in the head, one will definitely try his best to stop him or her.

When we see a smoker, we see someone who’s committing suicide—although a slow-motion one compared to someone trying to commit it in an instant. But it’s still killing oneself; the difference is just in the time it takes to effect the suicide.

This is the grim reality that the 17 million or more smokers in the country don’t seem to realize, or choose not to realize. And we’re not only talking about lung cancer as the only hazard smoking causes. Earlier this week, the current president of the Philippine Heart Association, Dr. Saturnino “Bong” Javier, told media of his 17-year-old patient who has severely clogged arteries already, likely attributable to his heavy smoking.

‘Smokingest’ country

This may be a rarity for now, but if we don’t implement measures to prevent our children and teenagers from spending their allowance to buy cheap cigarettes, it would become fairly common; and we’ll have the distinction of having the most number of young patients with clogged arteries alongside our current distinction of being the “smokingest” country in Southeast Asia.

We’ve already emphasized previously that smoking is a risk factor for six of the eight leading causes of preventable deaths, and these diseases are predominantly present in low-to middle-income countries, like the Philippines. Here, smoking is a major risk factor in causing the top four killers, namely, heart attacks, strokes, chronic obstructive lung diseases such as emphysema and bronchitis; and cancer of the lungs, airways and gastrointestinal tract.

We hope our good senators would finally realize the importance of passing a truly meaningful sin tax bill, not a pakonswelo, watered-down version. Based on some feedback from some people closely monitoring the developments, there seems to be an unenthusiastic response from the senators on the new version of the bill as “repackaged” by Sen. Franklin Drilon, who’s now the acting chair of the ways and means committee. Before the start of this week’s Senate session, the senators went into a private caucus and it was hinted by Senator Drilon himself that he got “a consensus from the members about the possibilities of compromise” on the sin tax bill that is acceptable to the majority of the senators.

We hope that the “compromises” will not diminish the meaningfulness of the sin tax bill.