Yesterday (Sunday) marked the worldwide No Tobacco Day. Prof. Zvi Fridlender, Chairman of the Israeli Pulmonology Association and Head of an Internal Medicine Department at Hadassah Medical Center discusses the harms of smoking, the difficulty of quitting, and ways to reduce the scope of the problem
Despite many years of public awareness campaigns and warnings, Prof. Fridlender believes that one of the greatest dangers of smoking and the greatest source of frustration for professionals in the field is that everyone is aware of the damage caused by smoking, yet not enough is being done to address it.
According to him, approximately 8,000 people die each year in Israel as a result of smoking-related harm. However, “not enough is being done. There is no enforcement, no legislation, no distancing of youth from smoking, and so on. Much of this is driven by economic considerations."
Regarding measures that could reduce the prevalence of smoking, Prof. Fridlender emphasizes the importance of increasing taxes on tobacco and nicotine products. He also criticizes the lack of enforcement in various areas, saying: “The duty-free exemption for bringing cigarettes into the country is terrible. There is no enforcement of smoking bans near schools. There is also the entire issue of nicotine substitutes that introduce teenagers to the world of smoking, without any real fight against advertising and sales to minors. The state receives billions of shekels from taxes on cigarettes and nicotine products but does not invest enough in education for stopping to smoke. This is an epidemic that can and should be fought, but it isn’t."
Prof. Fridlender states unequivocally that teenagers have become victims of economic interests. According to him, “Cigarette and nicotine companies invest heavily in young people. One study found that near every high school there are stores selling tobacco products, designed to appeal to teenagers. This is the gateway to smoking. It starts there and progresses to regular smoking, after which quitting becomes difficult. Once people begin, it is hard to stop, both physically and mentally. It is a genuine addiction. We should not blame those who become addicted as much as we should blame those who expose our youth and our soldiers to the harms of smoking and turn them into addicts."
Prof. Fridlender also addressed addiction among adults and the reasons many people struggle to quit despite being fully aware of the risks.
“There are still environmental, psychological, and addictive factors at play. We saw a return to smoking among former smokers during the years of the war. There are many pressures that contribute to this. The Ministry of Health should have done more to make smoking more difficult, such as increasing taxes on cigarettes, which is recognized worldwide as a tool that helps people quit, while also reducing exposure and advertising. We allow these companies to advertise everywhere. The state needs to bridge the gap between understanding and recognizing the danger. People in their thirties and forties often do not think the disease will happen to them, but later disabilities develop, tumors appear, and heart and lung diseases emerge-and by then it is too late."
When asked what amount of smoking is considered dangerous, he replied that even relatively low levels of smoking can cause significant harm.
“More than two to three cigarettes a day is considered significant," he said, adding that “most people smoke between half a pack and a full pack a day. People think that once they quit, the symptoms will disappear immediately, but that is not the case. Suddenly it becomes difficult to walk or breathe because the damage has already been done. Nevertheless, quitting smoking is beneficial at any stage. Stopping smoking immediately improves lung function and reduces the risk of heart disease within two years. We know that the risk of lung cancer steadily declines over a period of 10 to 15 years until it approaches the level it was before."
In conclusion, Prof. Fridlender stressed that the quitting process must begin with the smoker’s personal decision, but at the same time the state and the healthcare system must be significant partners in the effort. According to him, smoking cessation workshops, medications, and nicotine replacement therapies can help, but without a clear policy of education, enforcement, and taxation, it will be difficult to achieve broad-scale change.
“People say, ‘At worst, I’ll die,’ but that is not the point," he concluded. “What we are talking about is a life of suffering, with many additional consequences that can be reduced-or even prevented altogether."