SlideShare a Scribd company logo
The Campaign to Discourage Smoking
A Public Health Success Story?
Can we use the same tools against COVID-19?
Mask Up, Get
Vaccinated!
Robert J Miller MD
August 2021
Your beauty up in
smoke
The Ugh
The Ugly Truth
In the campaign to
reduce smoking we
pulled out all of the
stops and went after
smokers
Is it time to push back
against the no-mask
and no-vaccine
crowd?
Pick One
Too harsh?
How did we push
cigarette smoking
rates back down?
How critical was trust in our success in
lowering cigarette smoking?
Change in Percent Smokers from 1965 to 2018
52%
15.8%
34.1%
12.2%
Success?
After 50
years should
this be
better?
https://www.hhs.gov/sites/default/files/2020-cessation-sgr-full-report.pdf
Men: current smokers from 52% to 15.8% and Women: 34.1% to 12.2%
but in 2018 13.7% (34 million) still smoke costing $Billions in
health care costs
Success?
Tobacco use has been documented for over 8,000 years. Tobacco
cultivation likely began in 5000 BC with the development of maize-
based agriculture in Central Mexico. It was originally used by Native
Americans in religious ceremonies and for medical purposes.
In the late 15th century, Christopher Columbus was given tobacco as a
gift from the Native Americans. It gained instant popularity in Europe, for
they believed that tobacco had magical healing powers. Soon, the
smoking of tobacco was promoted as a viable way to get your “daily
dose of tobacco.”
Research has shown that the most potent demand-reducing influences on tobacco
use have been interventions that impact virtually all smokers repeatedly, such as
- higher taxes on tobacco products
- comprehensive advertising bans
- graphic pack warnings
- mass media campaigns
- smoke-free policies
Best Practices for Comprehensive
Tobacco Control Programs—2014
https://www.cdc.gov/tobacco/stateandcommunity/best_practices/index.htm
This comprehensive approach combines educational, clinical, regulatory,
economic, and social strategies.
Research has documented the effectiveness of laws and policies in a
comprehensive tobacco control effort to protect the public from secondhand
smoke exposure, promote cessation, and prevent initiation, including:
- increasing the unit price of tobacco products
- implementing comprehensive smoke free laws that prohibit smoking in all
indoor areas of worksites, restaurants, and bars, and encouraging smoke free
private settings such as multiunit housing
- providing insurance coverage of evidence-based tobacco cessation treatments
- limiting minors’ access to tobacco products.
Smoking Cessation: A Report of the
Surgeon General
2020
U.S. DEPARTMENT OF HEALTH AND
HUMAN SERVICES Public Health Service
Office of the Surgeon General Rockville,
MD
https://www.hhs.gov/sites/default/files/2020-cessation-sgr-
full-report.pdf
https://www.hhs.gov/sites/default/files/2020-cessation-sgr-full-report.pdf
https://www.cdc.gov/tobacco/data_statistics/fact_sheets/economics/econ_facts/index.htm
Economic Trends in Tobacco
(CDC)
By state, the average retail price of a pack of 20 cigarettes including federal and state excise taxes,
ranged from
$4.62 in Missouri to a high of $10.67 in New York, as of November 2017.
On average, federal and state excise taxes account for 44.3% of the retail price of cigarettes.
Increasing the price of tobacco products is the single most effective way to reduce
reduce consumption.
Simply educating smokers about the dangers
of smoking is not on the list of most effective
ways to reduce smoking!
Cigarette smoking is linked to about 80% to 90% of lung cancer deaths.
People who smoke cigarettes are 15 to 30 times more likely to get lung cancer or die from lung cancer than people who do not smoke.
About 10 to 15 percent of smokers develop lung cancer - 21% survival at 5 Years
67 percent of smokers perished from smoking-related illness.
https://www.cdc.gov/cancer/lu
ng/basic_info/risk_factors.htm
Lung Cancer in Smokers and Nonsmokers
How Many People Survive 5 Years Or More after
Being Diagnosed with Lung and Bronchus Cancer?
Cigarette Consumption in the US and Health Events
Cigarette Consumption in the US and Health Events
Cigarette Consumption in the US and Health Events
Cigarette Consumption in the US and Health Events
Cigarette Consumption in the US and Health Events
Cigarette Consumption in the US and Health Events
N
X
doubl
es
US enters
WWI
Depression
begins
US enters
WWII
Evidence
links
smoking
and cancer
1964 Surgeon
General Report
Synar amendment
Fairness
doctrine on
advertising
Non-
smokers
rights
Fed cig tax
doubles
Secondhand
smoke report
Broadcast ad
ban
Nicotine gum
Master settlement
agreement
Family smoking
protection act
Fed tax increase
Cig price
drop
FDA rule
Updates
Secondhand
smoke report
Benefits of lowering
smoking showed up
Lower lung cancer
deaths in men
Lower lung cancer
deaths in women
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010 2020
Men
Women
Smoking in the US
Humphrey Bogart
Dead at 57 from esophagus cancer in
1957
Men
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010 2020
Men
Women
Smoking in the US
Lauren Becall lived to be 89 and died
in 2014 of a stroke
Women
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010 2020
Men
Women
Steeper decline in smoking
among men and started
coming down sooner
More shallow decline in smoking among
women and started coming down later
Smoking Decline in the US
AUGUST 25, 2021
Study suggests women find it more difficult to quit smoking
than men
by European Society of Cardiology
despite smoking fewer cigarettes and being less
nicotine dependent than men, women find it more
difficult to quit.
Possible contributors could be the higher prevalence
of anxiety, depression and overweight or obesity
among women.
Women face different barriers to smoking cessation
related to fear of weight gain, sex hormones, and
mood.
https://seer.cancer.gov/explorer
Men peak was 1984
Women peak at 2005
Peak 1990
Peak 2002
So, who still smokes and why?
Is it educated, wealthy and successful people?
Is it poor, unsuccessful, uneducated and
unhappy people?
Percentage of adults aged ≥18 years who reported cigarette use “every day” or “some days,” by selected characteristics —
National Health Interview Survey, United States, 2019
https://www.cdc.gov/tobacco
2019 Statistics
Smoking by Level of
Education in 2019
“I love the poorly educated!”
Smoking by Income or
Health Insurance in 2019
Changing Social Norms about Smoking…then
Changing Social Norms about Smoking…now
Smoking By State in 2018
Utah 8.9%
California 11.3%
New York 14.1%
Texas 15.7%
Florida 16.1%
US 17.1%
Alabama 20.9%
Mississippi 22.2%
Kentucky 24.6%
West Virginia 26.0%
Lung Cancer Mortality by County in the US in 2014
Lung Cancer Incidence Rates by State for 2017
Lung Cancer Death Rates by State for 2017
https://gis.cdc.gov/Cancer/USCS/DataViz.html
Authority Task Trust
Government raise cost/restrict access and advertising Yes
Science educate public Yes
Media stop ads Yes
Culture/Politics de-glamorize smokers Yes
War against smoking (only villain was big tobacco)
Failures are people in distress or prone to addiction (and obviously
people who don’t care). Disease of despair?
Most smokers use tobacco regularly because they are addicted to nicotine.
Most smokers would like to stop smoking, and each year about half try to quit
permanently. Yet, only about 6 percent of smokers can quit each year.
https://www.drugabuse.gov/publications/research-
reports/tobacco-nicotine-e-cigarettes/nicotine-addictive
Aug 7, 2021
How’s it
going with
COVID?
The poor US response to Covid-19 has exposed multiple weakness in
our society including:
a malfunctioning public health system
a nonexistent national health system
a broken information system
such extreme cultural-political polarization that it raises
questions about the effectiveness of a democracy in
making equitable and coherent policy decisions.
The lowest levels of vaccine confidence were
found in countries with the highest education
levels and the best health-care systems
Successful vaccination effort requires the public
to trust the scientists who create the vaccine,
the companies that manufacture it, the health-
care workers who inject it, and the governments
that oversee the process.
That trust chain is a far more important lever of
acceptance than any piece of information,
Public Trust in Government: 1958-2021/
Public trust in government near historic
lows
https://www.pewresearch.org/politics/2021/05/17/public-trust-in-government-1958-2021/
Only about one-quarter of Americans say they can trust the government in Washington to do what is right “just
about always” (2%) or “most of the time” (22%).
Amid coronavirus threat, Americans
generally have a high level of trust in
medical doctors MARCH 13, 2020
Have a great deal or a fair amount of confidence
Medical Doctors 74%
Medical Research Scientists 68%
News Media 47%
Elected Officials 35%
https://www.pewresearch.org/fact-tank/2020/03/13/amid-coronavirus-threat-americans-generally-have-a-high-
level-of-trust-in-medical-doctors/
AUGUST 10, 2021
Nurses # 1
PROPORTION THAT
TRUSTS MOST NEWS
MOST OF THE TIME
https://reutersinstitute.politics.ox.ac.uk/sites/default/
files/2021-06/Digital_News_Report_2021_FINAL.pdf
US Lowest Trust
in Digital News
in the World in
2021
The Reuters Institute Digital
News Report 2021
https://news.gallup.com/poll/1597/confidence-institutions.aspx
Confidence in Institutions… list of institutions in American society. Please tell me how much
confidence you, yourself, have in each one -- a great deal, quite a lot, some or very little? 2020 Gallup Survey
The Military 72%
The Medical System 51%
Organized Religion 42%
The Presidency 39%
Newspapers 24%
Big Business 19%
Television News 18%
Congress 13%
Percent who answered: Great deal/ Quite a lot
We depend on the
‘Fourth Estate’ to
help us watch over
the government and
we have a broken
information system
https://www.nytimes.com/interactive/202
1/04/17/us/vaccine-hesitancy-
politics.html?smid=em-share
Trump voters more
vaccine hesitancy…
how did COVID
become political
https://www.pewresearch.org/science/2
021/03/05/growing-share-of-americans-
say-they-plan-to-get-a-covid-19-vaccine-
or-already-have/
Trump decided to minimize the
seriousness of COVID his
messaging often came into
conflict with public health
This forced his supporters to
show their loyalty by
denigrating the input from
public health
Public Health didn’t help itself
with faulty messaging
Don’t
trust
Fauci!
https://www.pewresearch.org/science/2021/03/05/growing-share-of-americans-say-they-plan-to-get-a-covid-19-vaccine-or-already-have/
The risk to the economy they
could see with their own eyes,
the health risks required trust in
“experts”
Biggest jump in
deaths in a
century!
Between 2018 and 2020, life expectancy in the US decreased by 1.87
years (to 76.87 years), 8.5 times the average decrease in peer
countries (0.22 years), widening the gap to 4.69 years.
Life expectancy in the US decreased disproportionately among racial
and ethnic minority groups between
https://www.bmj.com/content/373/bmj.n1343
Historic Drop in Life Expectancy in the United States
https://morningconsult.com/views-on-the-pandemic/
Democrats and Health
Republicans and Health
https://morningconsult.com/views-on-the-pandemic/
Republicans and Economy
Cases
Cases
Hospitalizations
Hospitalizations
Deaths
Deaths
Not Going Well in the US
Despite overwhelming medical information about the
gravity of this pandemic, some people promote resistance
to mitigation efforts
How to behave if you are a
true patriot
The best way to protect every one’s freedom is to oppose any
effort by the government to limit your personal freedom,
unless…
We are in a once in a century public health crisis that
threatens the health and economy of all Americans
With smoking, information (science based) had an impact but needed
government and regulatory participation to make it more expensive, illegal
and inconvenient to smoke and
the media cooperated in making it less sexy or desirable to smoke and
cancelling tobacco advertising.
There was no organized opposition to this other than the limited false
advertising from big tobacco and a dwindling number of angry smokers.
With COVID the science has been challenged almost from the beginning and
there was been organized opposition to mitigation and vaccination
strategies on a political basis, and government restrictions have been
challenged in the courts and by state legislators.
The media has been polarized as well as discredited by obvious bias and
over-reach along with outrageous misinformation!
Makes you wonder If the virus has
a secret advocate rooting for its
success!
Authority Task Trust
Government shut down cities and require masks NO
Science does mitigation work/vaccines safe NO
Media media provide accurate information NO
Culture/Politics encourage responsible behavior NO
War against COVID
The villain was us!
Look Familiar?
Smokers Low Vaccine
Survey: Misinformation affects vaccine hesitancy
Tampa Bay Times June 19, 2021
- Main reasons cited were based on misinformation about the scientific
facts
- Most people trust advice from their personal physician
- But most people no longer have a relationship with a personal physician
https://www.nytimes.com/2021/07/31/us/virus-unvaccinated-
americans.html?referringSource=articleShare
Almost
nothing
will
convince
these
people
“In God we trust…everyone else bring data!”
People need more than impersonal ‘data’ they need a relationship with a
health care provisor based on trust
TRUST
Countering antivaccination attitudes
Proc Natl Acad Sci U S A. 2015 Aug 18; 112(33): 10321–10324.
https://www.ncbi.nlm.nih.gov/pmc/articles/PM
C4547299/
Randomized trial on the best way to deal with anti-vaccer parent who claims
vaccines cause autism they tried two different approaches:
Giving them new info about the harm of getting sick was
most effective
Confronting them about their mistaken beliefs about
autism was not effective
Does use of the expression
“out of an abundance of
caution…” justify ignoring
science?
If you’re a doctor be honest,
don’t say you are following
the science when you aren’t
Is it in your best interest to behave honestly with transparency?
Politician: No….they want power (stay in office and hide their sources
of campaign contributions, a gaffe : accidently telling the truth)
Media and Social Media: Maybe….they want ratings (conspiracy and
polarization are good for ratings, some have reputations to preserve)
Big Pharma: No…they want block buster drugs (whether they work or
not so the least scrutiny the better)
Physicians and Scientists: Hopefully Yes (if reputation,
legacy and influence are more important than
fame and fortune)
Before you
start
pontificating or
arguing with
others, stop
and challenge
your own
beliefs.
when we ponder and speak, we often do so with the mindset of three different
professions
The preacher let me emphasize why I know I’m right.
The prosecutor let me point out why I’m sure you’re
wrong
The politician, I guess we’re all right.
To be successful think like a scientist.
Treat your position as a working hypothesis that may
turn out to be wrong as new information comes
along, show a little humility.
Isaac Newton
Hypotheses non fingo
“I do not feign hypotheses”
It’s OK to say, “I don’t know.”
When pushed to explain not just
how gravity worked but why it
worked, he said:
Richard Feynman
the physicist Richard Feynman discussing
scientific integrity:
“The first principle is that you must
not fool yourself—and you are the
easiest person to fool.”
The default position in testing your hypothesis is the null hypothesis
(i.e. assume you are wrong and have proved nothing) to try to avoid
confirmation bias.
How the medical experts should have presented their
advice on COVID
1. It’s a new (novel) virus, but since we’re in an emergency, we will start out treating this
like other Corona viruses that we know about until we have more information
2. We will start collecting reliable information by urgently setting up widespread
surveillance testing and high-quality randomized trials
3. All the high-quality data will be presented in real time as it comes in and be widely
shared with the public and scientific community
4. Guidelines on management will be continuously updated by expert panels with
expertise in public health and infectious disease and shared widely along with the data
and rationale for any changes made
Coach: “Son, I don’t know if
your problem is ignorance or
apathy?”
Player: “Well coach, I don’t
know, and I don’t care!”
Ignorance or Apathy…the public
The public needs to feel an obligation to be
educated and to keep informed.
Like Moore’s Law Information Technology (and information)
has been growing exponentially for over a century!
Soon this
will exceed
human
brain
power
Thank You for Being Late | Thomas L. Friedman
We are all (almost all) now too stupid
to understand what’s going on
Most people are comfortable in
their ignorance
A few people (polymaths
and scholars) are trying to
keep up
And Information
34% 13.6% 2.1% 0.13%
What if you now need an IQ
of at least 130 to understand
nuance and complexity
How best to run a
democracy (100% or 16%
to make decisions)
Democracy is a pathetic
belief in the collective
wisdom of individual
ignorance.
A newspaper is a device for
making the ignorant more
ignorant and the crazy
crazier. HL Mencken
And finally, to consider how their behavior benefits
society rather than themselves
We don’t
just have
cognitive
failure we
have a
spiritual
failure
Why So Many Tennis Players Don’t Want the Covid Vaccine
Despite the possible consequences of not being vaccinated — illness and
the loss of income and opportunity to play — tennis players have been
stubbornly slow to get the vaccine.
“Whether someone wants
to get a vaccine or not,
that’s completely up to
them,” Djokovic said. “I
hope that it stays that way.”
New York Times / Aug. 30, 2021
N
X
doubl
es
US enters
WWI
Depression
begins
US enters
WWII
Evidence
links
smoking
and cancer
1964 Surgeon
General Report
Synar amendment
Fairness
doctrine on
advertising
Non-
smokers
rights
Fed cig tax
doubles
Secondhand
smoke report
Broadcast ad
ban
Nicotine gum
Master settlement
agreement
Family smoking
protection act
Fed tax increase
Cig price
drop
FDA rule
Updates
Secondhand
smoke report
Non-smokers rights,
do the vaccinated
have any rights?
Public:
1.need to be less selfish
2. work to be better informed and less credulous
(or gullible)
3.Need to put pressure to force accountability
and transparency from all the bad actors (media,
government, industry)
Experts (authority):
the honest ones need to realize that
the avalanche of new information
does not automatically turn into public knowledge
unless…
the experts maintain (or earn) public trust
(competent/unbiased/honest) and …
present this new information in a format explicable
(accessible) to the general public
So, what strategy makes sense?
1. Advice for the Public
2. Advice for Experts/Authorities
3. Policy makers: appealing to the ‘good sense’ and altruism
of your fellow Americans won’t get the job done (in time) ,
so you need to move ahead with mandates that limit access
to people not vaccinated or not practicing proper mitigation
strategies
In 1905 the Supreme Court confirmed a Massachusetts law that
empowered cities’ boards of health to mandate smallpox vaccination of all
residents
reciting the principle that individual liberty is not absolute in the face of
“the common good,” and that “real liberty for all” depends on restraining
individual exercises of liberty that harm others.
The pre-COVID legal landscape is quite clear: a state can require
vaccinations to protect public health, even imposing criminal penalties for
noncompliance and vaccination as a condition of attending school or of
government employment
Sept. 2, 2021
We Work at the A.C.L.U. Here’s What We Think About
Vaccine Mandates. David Cole and Daniel Mach
We see no civil liberties problem with requiring Covid-19
vaccines in most circumstances. The disease is highly
transmissible, serious and often lethal; the vaccines are safe
and effective; and crucially there is no equally effective
alternative available to protect public health.
In fact, far from compromising civil liberties, vaccine mandates
actually further civil liberties
Opposed to Vaccine mandates Approve Mandates
https://www.medrxiv.org
/content/10.1101/2021.0
1.31.21250866v1.full.pdf
Survey 15,536 adults in
13 countries
How the
people of
various
countries think
about their
government
imposing these
mandates
New Normal?
How many people
think we should
continue to save
lives?
How Is this even
controversial?
Maybe there
are Two
Americas?

More Related Content

What's hot

Small Cell Lung Cancer
Small Cell Lung CancerSmall Cell Lung Cancer
Small Cell Lung Cancer
Robert J Miller MD
 
Lung cancer
Lung cancer Lung cancer
Lung cancer
peyman2015
 
Small Cell Lung Cancer Management by Dr.Tinku Joseph
Small Cell Lung Cancer Management by Dr.Tinku JosephSmall Cell Lung Cancer Management by Dr.Tinku Joseph
Small Cell Lung Cancer Management by Dr.Tinku Joseph
Dr.Tinku Joseph
 
Lung Cancer : Update on Diagnosis and Treatment Lung Cancer : Update on Dia...
Lung Cancer : Update on Diagnosis and Treatment 	 Lung Cancer : Update on Dia...Lung Cancer : Update on Diagnosis and Treatment 	 Lung Cancer : Update on Dia...
Lung Cancer : Update on Diagnosis and Treatment Lung Cancer : Update on Dia...
MedicineAndHealthCancer
 
Small Cell Carcinoma of Lung
Small Cell Carcinoma of LungSmall Cell Carcinoma of Lung
Small Cell Carcinoma of Lung
Santam Chakraborty
 
Small cell lung cancer
Small cell lung cancerSmall cell lung cancer
Small cell lung cancer
Dr. Yogesh Belagali
 
Lung Cancer
Lung CancerLung Cancer
Lung Cancer
Robert J Miller MD
 
Tobacco and cancer
Tobacco and cancerTobacco and cancer
Tobacco and cancer
Sanketh Kotne
 
ANATOMY,PATHOLOGY, INVESTIGATIVE WORK –UP AND STAGING OF LUNG CANCER
ANATOMY,PATHOLOGY, INVESTIGATIVE WORK –UP AND STAGING OF LUNG CANCERANATOMY,PATHOLOGY, INVESTIGATIVE WORK –UP AND STAGING OF LUNG CANCER
ANATOMY,PATHOLOGY, INVESTIGATIVE WORK –UP AND STAGING OF LUNG CANCER
LAKSHMI DEEPTHI GEDELA
 
Prophylactic cranial irradiation
Prophylactic cranial irradiationProphylactic cranial irradiation
Prophylactic cranial irradiation
Shreya Singh
 
Lung Cancer
Lung CancerLung Cancer
Lung Cancer
guestaa82de
 
Non Small Cell Lung Cancer
Non Small Cell Lung CancerNon Small Cell Lung Cancer
Non Small Cell Lung Cancer
fondas vakalis
 
Radiotherapy For Non Small Cell Lung Cancer
Radiotherapy For Non Small Cell Lung CancerRadiotherapy For Non Small Cell Lung Cancer
Radiotherapy For Non Small Cell Lung Cancer
fondas vakalis
 
Cancer Epidemiology part I
Cancer Epidemiology part ICancer Epidemiology part I
Cancer Epidemiology part I
Tarek Tawfik Amin
 
Effect of radiation therapy on the lung
Effect of radiation therapy on the lungEffect of radiation therapy on the lung
Effect of radiation therapy on the lung
Suchanar Rungrojanarak
 
Non small cell ca
Non small cell caNon small cell ca
Non small cell ca
Kiran Ramakrishna
 
Radiation Pneumonitis
Radiation PneumonitisRadiation Pneumonitis
Radiation Pneumonitis
HEBAGOMAA1984
 
All About Lung Cancer
All  About Lung Cancer All  About Lung Cancer
All About Lung Cancer
Andrea Borondy Kitts
 
Targeted therapy in lung cancer
Targeted therapy in lung cancerTargeted therapy in lung cancer
Targeted therapy in lung cancer
Shriram Shenoy
 
Lungcancer
Lungcancer Lungcancer

What's hot (20)

Small Cell Lung Cancer
Small Cell Lung CancerSmall Cell Lung Cancer
Small Cell Lung Cancer
 
Lung cancer
Lung cancer Lung cancer
Lung cancer
 
Small Cell Lung Cancer Management by Dr.Tinku Joseph
Small Cell Lung Cancer Management by Dr.Tinku JosephSmall Cell Lung Cancer Management by Dr.Tinku Joseph
Small Cell Lung Cancer Management by Dr.Tinku Joseph
 
Lung Cancer : Update on Diagnosis and Treatment Lung Cancer : Update on Dia...
Lung Cancer : Update on Diagnosis and Treatment 	 Lung Cancer : Update on Dia...Lung Cancer : Update on Diagnosis and Treatment 	 Lung Cancer : Update on Dia...
Lung Cancer : Update on Diagnosis and Treatment Lung Cancer : Update on Dia...
 
Small Cell Carcinoma of Lung
Small Cell Carcinoma of LungSmall Cell Carcinoma of Lung
Small Cell Carcinoma of Lung
 
Small cell lung cancer
Small cell lung cancerSmall cell lung cancer
Small cell lung cancer
 
Lung Cancer
Lung CancerLung Cancer
Lung Cancer
 
Tobacco and cancer
Tobacco and cancerTobacco and cancer
Tobacco and cancer
 
ANATOMY,PATHOLOGY, INVESTIGATIVE WORK –UP AND STAGING OF LUNG CANCER
ANATOMY,PATHOLOGY, INVESTIGATIVE WORK –UP AND STAGING OF LUNG CANCERANATOMY,PATHOLOGY, INVESTIGATIVE WORK –UP AND STAGING OF LUNG CANCER
ANATOMY,PATHOLOGY, INVESTIGATIVE WORK –UP AND STAGING OF LUNG CANCER
 
Prophylactic cranial irradiation
Prophylactic cranial irradiationProphylactic cranial irradiation
Prophylactic cranial irradiation
 
Lung Cancer
Lung CancerLung Cancer
Lung Cancer
 
Non Small Cell Lung Cancer
Non Small Cell Lung CancerNon Small Cell Lung Cancer
Non Small Cell Lung Cancer
 
Radiotherapy For Non Small Cell Lung Cancer
Radiotherapy For Non Small Cell Lung CancerRadiotherapy For Non Small Cell Lung Cancer
Radiotherapy For Non Small Cell Lung Cancer
 
Cancer Epidemiology part I
Cancer Epidemiology part ICancer Epidemiology part I
Cancer Epidemiology part I
 
Effect of radiation therapy on the lung
Effect of radiation therapy on the lungEffect of radiation therapy on the lung
Effect of radiation therapy on the lung
 
Non small cell ca
Non small cell caNon small cell ca
Non small cell ca
 
Radiation Pneumonitis
Radiation PneumonitisRadiation Pneumonitis
Radiation Pneumonitis
 
All About Lung Cancer
All  About Lung Cancer All  About Lung Cancer
All About Lung Cancer
 
Targeted therapy in lung cancer
Targeted therapy in lung cancerTargeted therapy in lung cancer
Targeted therapy in lung cancer
 
Lungcancer
Lungcancer Lungcancer
Lungcancer
 

Similar to Smoking and lung cancer and now Covid

Tobacco Winnable Battle presentation
Tobacco Winnable Battle presentationTobacco Winnable Battle presentation
Tobacco Winnable Battle presentation
PublicHealthFoundation
 
Rural Health: Grays Harbor County
Rural Health: Grays Harbor CountyRural Health: Grays Harbor County
Rural Health: Grays Harbor County
psanchez8
 
The best health news over the last decade
The best health news over the last decadeThe best health news over the last decade
The best health news over the last decade
JA Larson
 
Why states should fund comprehensive tc programs
Why states should fund comprehensive tc programsWhy states should fund comprehensive tc programs
The Vaping Truth About the CDC's Teen Tobacco Survey
The Vaping Truth About the CDC's Teen Tobacco SurveyThe Vaping Truth About the CDC's Teen Tobacco Survey
The Vaping Truth About the CDC's Teen Tobacco Survey
SFATA
 
Tobaccoprogress2012
Tobaccoprogress2012Tobaccoprogress2012
Tobaccoprogress2012
Hasan Mehmood
 
Control tobacco
Control tobaccoControl tobacco
Control tobacco
Georgi Daskalov
 
NUR 512: Community Health Program Evaluation
NUR 512: Community Health Program Evaluation NUR 512: Community Health Program Evaluation
NUR 512: Community Health Program Evaluation
Julmiste35
 
Centro Healthcare Category
Centro Healthcare Category Centro Healthcare Category
Centro Healthcare Category
Centro
 
Tobacco health512
Tobacco health512Tobacco health512
Tobacco health512
kguy2know
 
Anti ads
Anti adsAnti ads
Anti ads
briandolan123
 
Chemicals & Our Health - Why Recent Science is a Call to Action
Chemicals & Our Health - Why Recent Science is a Call to Action Chemicals & Our Health - Why Recent Science is a Call to Action
Chemicals & Our Health - Why Recent Science is a Call to Action
v2zq
 
US E-cigarette Summit: Taming the nicotine industrial complex
US E-cigarette Summit: Taming the nicotine industrial complexUS E-cigarette Summit: Taming the nicotine industrial complex
US E-cigarette Summit: Taming the nicotine industrial complex
Clive Bates
 
Anti ads 2
Anti ads 2Anti ads 2
Anti ads 2
briandolan123
 
The future of healthcare and big data
The future of healthcare and big dataThe future of healthcare and big data
The future of healthcare and big data
Charles Barnett
 
Corporate Wellness
Corporate WellnessCorporate Wellness
Corporate Wellness
guestabd728
 
HEALTH CARE & PHARMACEUTICAL BUSINESS: KEY CHALLENGES & IT VALUE
HEALTH CARE & PHARMACEUTICAL BUSINESS: KEY CHALLENGES & IT VALUEHEALTH CARE & PHARMACEUTICAL BUSINESS: KEY CHALLENGES & IT VALUE
HEALTH CARE & PHARMACEUTICAL BUSINESS: KEY CHALLENGES & IT VALUE
Mauricio Campos Suarez
 
CDC Update: Joining Forces to Reduce Tobacco and Cancer Among Behavioral Heal...
CDC Update: Joining Forces to Reduce Tobacco and Cancer Among Behavioral Heal...CDC Update: Joining Forces to Reduce Tobacco and Cancer Among Behavioral Heal...
CDC Update: Joining Forces to Reduce Tobacco and Cancer Among Behavioral Heal...
sfary
 
Managed care power point assign
Managed care power point assignManaged care power point assign
Managed care power point assign
cpryor52
 
Drug costs
Drug costsDrug costs
Drug costs
Richard Meyer
 

Similar to Smoking and lung cancer and now Covid (20)

Tobacco Winnable Battle presentation
Tobacco Winnable Battle presentationTobacco Winnable Battle presentation
Tobacco Winnable Battle presentation
 
Rural Health: Grays Harbor County
Rural Health: Grays Harbor CountyRural Health: Grays Harbor County
Rural Health: Grays Harbor County
 
The best health news over the last decade
The best health news over the last decadeThe best health news over the last decade
The best health news over the last decade
 
Why states should fund comprehensive tc programs
Why states should fund comprehensive tc programsWhy states should fund comprehensive tc programs
Why states should fund comprehensive tc programs
 
The Vaping Truth About the CDC's Teen Tobacco Survey
The Vaping Truth About the CDC's Teen Tobacco SurveyThe Vaping Truth About the CDC's Teen Tobacco Survey
The Vaping Truth About the CDC's Teen Tobacco Survey
 
Tobaccoprogress2012
Tobaccoprogress2012Tobaccoprogress2012
Tobaccoprogress2012
 
Control tobacco
Control tobaccoControl tobacco
Control tobacco
 
NUR 512: Community Health Program Evaluation
NUR 512: Community Health Program Evaluation NUR 512: Community Health Program Evaluation
NUR 512: Community Health Program Evaluation
 
Centro Healthcare Category
Centro Healthcare Category Centro Healthcare Category
Centro Healthcare Category
 
Tobacco health512
Tobacco health512Tobacco health512
Tobacco health512
 
Anti ads
Anti adsAnti ads
Anti ads
 
Chemicals & Our Health - Why Recent Science is a Call to Action
Chemicals & Our Health - Why Recent Science is a Call to Action Chemicals & Our Health - Why Recent Science is a Call to Action
Chemicals & Our Health - Why Recent Science is a Call to Action
 
US E-cigarette Summit: Taming the nicotine industrial complex
US E-cigarette Summit: Taming the nicotine industrial complexUS E-cigarette Summit: Taming the nicotine industrial complex
US E-cigarette Summit: Taming the nicotine industrial complex
 
Anti ads 2
Anti ads 2Anti ads 2
Anti ads 2
 
The future of healthcare and big data
The future of healthcare and big dataThe future of healthcare and big data
The future of healthcare and big data
 
Corporate Wellness
Corporate WellnessCorporate Wellness
Corporate Wellness
 
HEALTH CARE & PHARMACEUTICAL BUSINESS: KEY CHALLENGES & IT VALUE
HEALTH CARE & PHARMACEUTICAL BUSINESS: KEY CHALLENGES & IT VALUEHEALTH CARE & PHARMACEUTICAL BUSINESS: KEY CHALLENGES & IT VALUE
HEALTH CARE & PHARMACEUTICAL BUSINESS: KEY CHALLENGES & IT VALUE
 
CDC Update: Joining Forces to Reduce Tobacco and Cancer Among Behavioral Heal...
CDC Update: Joining Forces to Reduce Tobacco and Cancer Among Behavioral Heal...CDC Update: Joining Forces to Reduce Tobacco and Cancer Among Behavioral Heal...
CDC Update: Joining Forces to Reduce Tobacco and Cancer Among Behavioral Heal...
 
Managed care power point assign
Managed care power point assignManaged care power point assign
Managed care power point assign
 
Drug costs
Drug costsDrug costs
Drug costs
 

More from Robert J Miller MD

2022 Radiation for Common Cancers
2022 Radiation for Common Cancers2022 Radiation for Common Cancers
2022 Radiation for Common Cancers
Robert J Miller MD
 
Understanding advance directives
Understanding advance directivesUnderstanding advance directives
Understanding advance directives
Robert J Miller MD
 
What’s new in prostate cancer part 2, 2021
What’s new in prostate cancer part 2, 2021What’s new in prostate cancer part 2, 2021
What’s new in prostate cancer part 2, 2021
Robert J Miller MD
 
What’s new in prostate cancer part 1, 2021
What’s new in prostate cancer part 1, 2021What’s new in prostate cancer part 1, 2021
What’s new in prostate cancer part 1, 2021
Robert J Miller MD
 
Music and Aging
Music and AgingMusic and Aging
Music and Aging
Robert J Miller MD
 
Breast cancer 2021
Breast cancer 2021Breast cancer 2021
Breast cancer 2021
Robert J Miller MD
 
Viruses and cancer
Viruses and cancerViruses and cancer
Viruses and cancer
Robert J Miller MD
 
Cancer genetics
Cancer geneticsCancer genetics
Cancer genetics
Robert J Miller MD
 
How we eat affects our health
How we eat affects our healthHow we eat affects our health
How we eat affects our health
Robert J Miller MD
 
Cancer imaging
Cancer imagingCancer imaging
Cancer imaging
Robert J Miller MD
 
Happiness in a pandemic
Happiness in a pandemicHappiness in a pandemic
Happiness in a pandemic
Robert J Miller MD
 
Cancer screening for seniors
Cancer screening for seniorsCancer screening for seniors
Cancer screening for seniors
Robert J Miller MD
 
Cancer prevention aspec
Cancer prevention aspecCancer prevention aspec
Cancer prevention aspec
Robert J Miller MD
 
Cancer imaging
Cancer imagingCancer imaging
Cancer imaging
Robert J Miller MD
 
Using the internet to get smarter
Using the internet to get smarterUsing the internet to get smarter
Using the internet to get smarter
Robert J Miller MD
 
Oropharynx cancer and HPV in 2019
Oropharynx cancer and HPV in 2019Oropharynx cancer and HPV in 2019
Oropharynx cancer and HPV in 2019
Robert J Miller MD
 
Cancer prevention
Cancer preventionCancer prevention
Cancer prevention
Robert J Miller MD
 
Prostate Cancer and Gleason Score
Prostate Cancer and Gleason ScoreProstate Cancer and Gleason Score
Prostate Cancer and Gleason Score
Robert J Miller MD
 
Breast cancer staging 2018 video power points
Breast cancer staging 2018 video power pointsBreast cancer staging 2018 video power points
Breast cancer staging 2018 video power points
Robert J Miller MD
 
Screening for prostate cancer 2018
Screening for prostate cancer 2018Screening for prostate cancer 2018
Screening for prostate cancer 2018
Robert J Miller MD
 

More from Robert J Miller MD (20)

2022 Radiation for Common Cancers
2022 Radiation for Common Cancers2022 Radiation for Common Cancers
2022 Radiation for Common Cancers
 
Understanding advance directives
Understanding advance directivesUnderstanding advance directives
Understanding advance directives
 
What’s new in prostate cancer part 2, 2021
What’s new in prostate cancer part 2, 2021What’s new in prostate cancer part 2, 2021
What’s new in prostate cancer part 2, 2021
 
What’s new in prostate cancer part 1, 2021
What’s new in prostate cancer part 1, 2021What’s new in prostate cancer part 1, 2021
What’s new in prostate cancer part 1, 2021
 
Music and Aging
Music and AgingMusic and Aging
Music and Aging
 
Breast cancer 2021
Breast cancer 2021Breast cancer 2021
Breast cancer 2021
 
Viruses and cancer
Viruses and cancerViruses and cancer
Viruses and cancer
 
Cancer genetics
Cancer geneticsCancer genetics
Cancer genetics
 
How we eat affects our health
How we eat affects our healthHow we eat affects our health
How we eat affects our health
 
Cancer imaging
Cancer imagingCancer imaging
Cancer imaging
 
Happiness in a pandemic
Happiness in a pandemicHappiness in a pandemic
Happiness in a pandemic
 
Cancer screening for seniors
Cancer screening for seniorsCancer screening for seniors
Cancer screening for seniors
 
Cancer prevention aspec
Cancer prevention aspecCancer prevention aspec
Cancer prevention aspec
 
Cancer imaging
Cancer imagingCancer imaging
Cancer imaging
 
Using the internet to get smarter
Using the internet to get smarterUsing the internet to get smarter
Using the internet to get smarter
 
Oropharynx cancer and HPV in 2019
Oropharynx cancer and HPV in 2019Oropharynx cancer and HPV in 2019
Oropharynx cancer and HPV in 2019
 
Cancer prevention
Cancer preventionCancer prevention
Cancer prevention
 
Prostate Cancer and Gleason Score
Prostate Cancer and Gleason ScoreProstate Cancer and Gleason Score
Prostate Cancer and Gleason Score
 
Breast cancer staging 2018 video power points
Breast cancer staging 2018 video power pointsBreast cancer staging 2018 video power points
Breast cancer staging 2018 video power points
 
Screening for prostate cancer 2018
Screening for prostate cancer 2018Screening for prostate cancer 2018
Screening for prostate cancer 2018
 

Recently uploaded

vonoprazan A novel drug for GERD presentation
vonoprazan A novel drug for GERD presentationvonoprazan A novel drug for GERD presentation
vonoprazan A novel drug for GERD presentation
Dr.pavithra Anandan
 
Diabetic nephropathy diagnosis treatment
Diabetic nephropathy diagnosis treatmentDiabetic nephropathy diagnosis treatment
Diabetic nephropathy diagnosis treatment
arahmanzai5
 
All info about Diabetes and how to control it.
 All info about Diabetes and how to control it. All info about Diabetes and how to control it.
All info about Diabetes and how to control it.
Gokuldas Hospital
 
CHEMOTHERAPY_RDP_CHAPTER 4_ANTI VIRAL DRUGS.pdf
CHEMOTHERAPY_RDP_CHAPTER 4_ANTI VIRAL DRUGS.pdfCHEMOTHERAPY_RDP_CHAPTER 4_ANTI VIRAL DRUGS.pdf
CHEMOTHERAPY_RDP_CHAPTER 4_ANTI VIRAL DRUGS.pdf
rishi2789
 
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptxREGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
LaniyaNasrink
 
OCT Training Course for clinical practice Part 1
OCT Training Course for clinical practice Part 1OCT Training Course for clinical practice Part 1
OCT Training Course for clinical practice Part 1
KafrELShiekh University
 
CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1
CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1
CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1
rishi2789
 
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptxVestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
Dr. Rabia Inam Gandapore
 
Cardiac Assessment for B.sc Nursing Student.pdf
Cardiac Assessment for B.sc Nursing Student.pdfCardiac Assessment for B.sc Nursing Student.pdf
Cardiac Assessment for B.sc Nursing Student.pdf
shivalingatalekar1
 
The Electrocardiogram - Physiologic Principles
The Electrocardiogram - Physiologic PrinciplesThe Electrocardiogram - Physiologic Principles
The Electrocardiogram - Physiologic Principles
MedicoseAcademics
 
Role of Mukta Pishti in the Management of Hyperthyroidism
Role of Mukta Pishti in the Management of HyperthyroidismRole of Mukta Pishti in the Management of Hyperthyroidism
Role of Mukta Pishti in the Management of Hyperthyroidism
Dr. Jyothirmai Paindla
 
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central
19various
 
Part II - Body Grief: Losing parts of ourselves and our identity before, duri...
Part II - Body Grief: Losing parts of ourselves and our identity before, duri...Part II - Body Grief: Losing parts of ourselves and our identity before, duri...
Part II - Body Grief: Losing parts of ourselves and our identity before, duri...
bkling
 
Journal Article Review on Rasamanikya
Journal Article Review on RasamanikyaJournal Article Review on Rasamanikya
Journal Article Review on Rasamanikya
Dr. Jyothirmai Paindla
 
CHEMOTHERAPY_RDP_CHAPTER 1_ANTI TB DRUGS.pdf
CHEMOTHERAPY_RDP_CHAPTER 1_ANTI TB DRUGS.pdfCHEMOTHERAPY_RDP_CHAPTER 1_ANTI TB DRUGS.pdf
CHEMOTHERAPY_RDP_CHAPTER 1_ANTI TB DRUGS.pdf
rishi2789
 
Hemodialysis: Chapter 4, Dialysate Circuit - Dr.Gawad
Hemodialysis: Chapter 4, Dialysate Circuit - Dr.GawadHemodialysis: Chapter 4, Dialysate Circuit - Dr.Gawad
Hemodialysis: Chapter 4, Dialysate Circuit - Dr.Gawad
NephroTube - Dr.Gawad
 
CHEMOTHERAPY_RDP_CHAPTER 6_Anti Malarial Drugs.pdf
CHEMOTHERAPY_RDP_CHAPTER 6_Anti Malarial Drugs.pdfCHEMOTHERAPY_RDP_CHAPTER 6_Anti Malarial Drugs.pdf
CHEMOTHERAPY_RDP_CHAPTER 6_Anti Malarial Drugs.pdf
rishi2789
 
LOOPS in orthodontics t loop bull loop vertical loop mushroom loop stop loop
LOOPS in orthodontics t loop bull loop vertical loop mushroom loop stop loopLOOPS in orthodontics t loop bull loop vertical loop mushroom loop stop loop
LOOPS in orthodontics t loop bull loop vertical loop mushroom loop stop loop
debosmitaasanyal1
 
share - Lions, tigers, AI and health misinformation, oh my!.pptx
share - Lions, tigers, AI and health misinformation, oh my!.pptxshare - Lions, tigers, AI and health misinformation, oh my!.pptx
share - Lions, tigers, AI and health misinformation, oh my!.pptx
Tina Purnat
 
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptxEar and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
Dr. Rabia Inam Gandapore
 

Recently uploaded (20)

vonoprazan A novel drug for GERD presentation
vonoprazan A novel drug for GERD presentationvonoprazan A novel drug for GERD presentation
vonoprazan A novel drug for GERD presentation
 
Diabetic nephropathy diagnosis treatment
Diabetic nephropathy diagnosis treatmentDiabetic nephropathy diagnosis treatment
Diabetic nephropathy diagnosis treatment
 
All info about Diabetes and how to control it.
 All info about Diabetes and how to control it. All info about Diabetes and how to control it.
All info about Diabetes and how to control it.
 
CHEMOTHERAPY_RDP_CHAPTER 4_ANTI VIRAL DRUGS.pdf
CHEMOTHERAPY_RDP_CHAPTER 4_ANTI VIRAL DRUGS.pdfCHEMOTHERAPY_RDP_CHAPTER 4_ANTI VIRAL DRUGS.pdf
CHEMOTHERAPY_RDP_CHAPTER 4_ANTI VIRAL DRUGS.pdf
 
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptxREGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
 
OCT Training Course for clinical practice Part 1
OCT Training Course for clinical practice Part 1OCT Training Course for clinical practice Part 1
OCT Training Course for clinical practice Part 1
 
CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1
CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1
CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1
 
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptxVestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
 
Cardiac Assessment for B.sc Nursing Student.pdf
Cardiac Assessment for B.sc Nursing Student.pdfCardiac Assessment for B.sc Nursing Student.pdf
Cardiac Assessment for B.sc Nursing Student.pdf
 
The Electrocardiogram - Physiologic Principles
The Electrocardiogram - Physiologic PrinciplesThe Electrocardiogram - Physiologic Principles
The Electrocardiogram - Physiologic Principles
 
Role of Mukta Pishti in the Management of Hyperthyroidism
Role of Mukta Pishti in the Management of HyperthyroidismRole of Mukta Pishti in the Management of Hyperthyroidism
Role of Mukta Pishti in the Management of Hyperthyroidism
 
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central
 
Part II - Body Grief: Losing parts of ourselves and our identity before, duri...
Part II - Body Grief: Losing parts of ourselves and our identity before, duri...Part II - Body Grief: Losing parts of ourselves and our identity before, duri...
Part II - Body Grief: Losing parts of ourselves and our identity before, duri...
 
Journal Article Review on Rasamanikya
Journal Article Review on RasamanikyaJournal Article Review on Rasamanikya
Journal Article Review on Rasamanikya
 
CHEMOTHERAPY_RDP_CHAPTER 1_ANTI TB DRUGS.pdf
CHEMOTHERAPY_RDP_CHAPTER 1_ANTI TB DRUGS.pdfCHEMOTHERAPY_RDP_CHAPTER 1_ANTI TB DRUGS.pdf
CHEMOTHERAPY_RDP_CHAPTER 1_ANTI TB DRUGS.pdf
 
Hemodialysis: Chapter 4, Dialysate Circuit - Dr.Gawad
Hemodialysis: Chapter 4, Dialysate Circuit - Dr.GawadHemodialysis: Chapter 4, Dialysate Circuit - Dr.Gawad
Hemodialysis: Chapter 4, Dialysate Circuit - Dr.Gawad
 
CHEMOTHERAPY_RDP_CHAPTER 6_Anti Malarial Drugs.pdf
CHEMOTHERAPY_RDP_CHAPTER 6_Anti Malarial Drugs.pdfCHEMOTHERAPY_RDP_CHAPTER 6_Anti Malarial Drugs.pdf
CHEMOTHERAPY_RDP_CHAPTER 6_Anti Malarial Drugs.pdf
 
LOOPS in orthodontics t loop bull loop vertical loop mushroom loop stop loop
LOOPS in orthodontics t loop bull loop vertical loop mushroom loop stop loopLOOPS in orthodontics t loop bull loop vertical loop mushroom loop stop loop
LOOPS in orthodontics t loop bull loop vertical loop mushroom loop stop loop
 
share - Lions, tigers, AI and health misinformation, oh my!.pptx
share - Lions, tigers, AI and health misinformation, oh my!.pptxshare - Lions, tigers, AI and health misinformation, oh my!.pptx
share - Lions, tigers, AI and health misinformation, oh my!.pptx
 
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptxEar and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
 

Smoking and lung cancer and now Covid

  • 1. The Campaign to Discourage Smoking A Public Health Success Story? Can we use the same tools against COVID-19? Mask Up, Get Vaccinated! Robert J Miller MD August 2021
  • 2. Your beauty up in smoke The Ugh The Ugly Truth In the campaign to reduce smoking we pulled out all of the stops and went after smokers Is it time to push back against the no-mask and no-vaccine crowd?
  • 4. How did we push cigarette smoking rates back down?
  • 5. How critical was trust in our success in lowering cigarette smoking?
  • 6. Change in Percent Smokers from 1965 to 2018 52% 15.8% 34.1% 12.2% Success? After 50 years should this be better?
  • 7. https://www.hhs.gov/sites/default/files/2020-cessation-sgr-full-report.pdf Men: current smokers from 52% to 15.8% and Women: 34.1% to 12.2% but in 2018 13.7% (34 million) still smoke costing $Billions in health care costs Success?
  • 8. Tobacco use has been documented for over 8,000 years. Tobacco cultivation likely began in 5000 BC with the development of maize- based agriculture in Central Mexico. It was originally used by Native Americans in religious ceremonies and for medical purposes. In the late 15th century, Christopher Columbus was given tobacco as a gift from the Native Americans. It gained instant popularity in Europe, for they believed that tobacco had magical healing powers. Soon, the smoking of tobacco was promoted as a viable way to get your “daily dose of tobacco.”
  • 9.
  • 10. Research has shown that the most potent demand-reducing influences on tobacco use have been interventions that impact virtually all smokers repeatedly, such as - higher taxes on tobacco products - comprehensive advertising bans - graphic pack warnings - mass media campaigns - smoke-free policies
  • 11. Best Practices for Comprehensive Tobacco Control Programs—2014 https://www.cdc.gov/tobacco/stateandcommunity/best_practices/index.htm
  • 12. This comprehensive approach combines educational, clinical, regulatory, economic, and social strategies. Research has documented the effectiveness of laws and policies in a comprehensive tobacco control effort to protect the public from secondhand smoke exposure, promote cessation, and prevent initiation, including: - increasing the unit price of tobacco products - implementing comprehensive smoke free laws that prohibit smoking in all indoor areas of worksites, restaurants, and bars, and encouraging smoke free private settings such as multiunit housing - providing insurance coverage of evidence-based tobacco cessation treatments - limiting minors’ access to tobacco products.
  • 13. Smoking Cessation: A Report of the Surgeon General 2020 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Office of the Surgeon General Rockville, MD https://www.hhs.gov/sites/default/files/2020-cessation-sgr- full-report.pdf
  • 15. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/economics/econ_facts/index.htm Economic Trends in Tobacco (CDC) By state, the average retail price of a pack of 20 cigarettes including federal and state excise taxes, ranged from $4.62 in Missouri to a high of $10.67 in New York, as of November 2017. On average, federal and state excise taxes account for 44.3% of the retail price of cigarettes. Increasing the price of tobacco products is the single most effective way to reduce reduce consumption.
  • 16. Simply educating smokers about the dangers of smoking is not on the list of most effective ways to reduce smoking!
  • 17. Cigarette smoking is linked to about 80% to 90% of lung cancer deaths. People who smoke cigarettes are 15 to 30 times more likely to get lung cancer or die from lung cancer than people who do not smoke. About 10 to 15 percent of smokers develop lung cancer - 21% survival at 5 Years 67 percent of smokers perished from smoking-related illness. https://www.cdc.gov/cancer/lu ng/basic_info/risk_factors.htm Lung Cancer in Smokers and Nonsmokers
  • 18. How Many People Survive 5 Years Or More after Being Diagnosed with Lung and Bronchus Cancer?
  • 19. Cigarette Consumption in the US and Health Events
  • 20. Cigarette Consumption in the US and Health Events
  • 21. Cigarette Consumption in the US and Health Events
  • 22. Cigarette Consumption in the US and Health Events
  • 23. Cigarette Consumption in the US and Health Events
  • 24. Cigarette Consumption in the US and Health Events
  • 25. N X doubl es US enters WWI Depression begins US enters WWII Evidence links smoking and cancer 1964 Surgeon General Report Synar amendment Fairness doctrine on advertising Non- smokers rights Fed cig tax doubles Secondhand smoke report Broadcast ad ban Nicotine gum Master settlement agreement Family smoking protection act Fed tax increase Cig price drop FDA rule Updates Secondhand smoke report
  • 26. Benefits of lowering smoking showed up Lower lung cancer deaths in men Lower lung cancer deaths in women
  • 27. 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010 2020 Men Women Smoking in the US Humphrey Bogart Dead at 57 from esophagus cancer in 1957 Men
  • 28. 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010 2020 Men Women Smoking in the US Lauren Becall lived to be 89 and died in 2014 of a stroke Women
  • 29. 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010 2020 Men Women Steeper decline in smoking among men and started coming down sooner More shallow decline in smoking among women and started coming down later Smoking Decline in the US
  • 30.
  • 31. AUGUST 25, 2021 Study suggests women find it more difficult to quit smoking than men by European Society of Cardiology despite smoking fewer cigarettes and being less nicotine dependent than men, women find it more difficult to quit. Possible contributors could be the higher prevalence of anxiety, depression and overweight or obesity among women. Women face different barriers to smoking cessation related to fear of weight gain, sex hormones, and mood.
  • 34. So, who still smokes and why? Is it educated, wealthy and successful people? Is it poor, unsuccessful, uneducated and unhappy people?
  • 35. Percentage of adults aged ≥18 years who reported cigarette use “every day” or “some days,” by selected characteristics — National Health Interview Survey, United States, 2019 https://www.cdc.gov/tobacco
  • 37. Smoking by Level of Education in 2019 “I love the poorly educated!”
  • 38. Smoking by Income or Health Insurance in 2019
  • 39. Changing Social Norms about Smoking…then
  • 40. Changing Social Norms about Smoking…now
  • 41. Smoking By State in 2018 Utah 8.9% California 11.3% New York 14.1% Texas 15.7% Florida 16.1% US 17.1% Alabama 20.9% Mississippi 22.2% Kentucky 24.6% West Virginia 26.0%
  • 42. Lung Cancer Mortality by County in the US in 2014
  • 43. Lung Cancer Incidence Rates by State for 2017
  • 44. Lung Cancer Death Rates by State for 2017 https://gis.cdc.gov/Cancer/USCS/DataViz.html
  • 45. Authority Task Trust Government raise cost/restrict access and advertising Yes Science educate public Yes Media stop ads Yes Culture/Politics de-glamorize smokers Yes War against smoking (only villain was big tobacco) Failures are people in distress or prone to addiction (and obviously people who don’t care). Disease of despair?
  • 46. Most smokers use tobacco regularly because they are addicted to nicotine. Most smokers would like to stop smoking, and each year about half try to quit permanently. Yet, only about 6 percent of smokers can quit each year. https://www.drugabuse.gov/publications/research- reports/tobacco-nicotine-e-cigarettes/nicotine-addictive
  • 47. Aug 7, 2021 How’s it going with COVID?
  • 48. The poor US response to Covid-19 has exposed multiple weakness in our society including: a malfunctioning public health system a nonexistent national health system a broken information system such extreme cultural-political polarization that it raises questions about the effectiveness of a democracy in making equitable and coherent policy decisions.
  • 49. The lowest levels of vaccine confidence were found in countries with the highest education levels and the best health-care systems Successful vaccination effort requires the public to trust the scientists who create the vaccine, the companies that manufacture it, the health- care workers who inject it, and the governments that oversee the process. That trust chain is a far more important lever of acceptance than any piece of information,
  • 50. Public Trust in Government: 1958-2021/ Public trust in government near historic lows https://www.pewresearch.org/politics/2021/05/17/public-trust-in-government-1958-2021/ Only about one-quarter of Americans say they can trust the government in Washington to do what is right “just about always” (2%) or “most of the time” (22%).
  • 51. Amid coronavirus threat, Americans generally have a high level of trust in medical doctors MARCH 13, 2020 Have a great deal or a fair amount of confidence Medical Doctors 74% Medical Research Scientists 68% News Media 47% Elected Officials 35% https://www.pewresearch.org/fact-tank/2020/03/13/amid-coronavirus-threat-americans-generally-have-a-high- level-of-trust-in-medical-doctors/
  • 53. PROPORTION THAT TRUSTS MOST NEWS MOST OF THE TIME https://reutersinstitute.politics.ox.ac.uk/sites/default/ files/2021-06/Digital_News_Report_2021_FINAL.pdf US Lowest Trust in Digital News in the World in 2021 The Reuters Institute Digital News Report 2021
  • 54. https://news.gallup.com/poll/1597/confidence-institutions.aspx Confidence in Institutions… list of institutions in American society. Please tell me how much confidence you, yourself, have in each one -- a great deal, quite a lot, some or very little? 2020 Gallup Survey The Military 72% The Medical System 51% Organized Religion 42% The Presidency 39% Newspapers 24% Big Business 19% Television News 18% Congress 13% Percent who answered: Great deal/ Quite a lot We depend on the ‘Fourth Estate’ to help us watch over the government and we have a broken information system
  • 56. https://www.pewresearch.org/science/2 021/03/05/growing-share-of-americans- say-they-plan-to-get-a-covid-19-vaccine- or-already-have/ Trump decided to minimize the seriousness of COVID his messaging often came into conflict with public health This forced his supporters to show their loyalty by denigrating the input from public health Public Health didn’t help itself with faulty messaging
  • 58. https://www.pewresearch.org/science/2021/03/05/growing-share-of-americans-say-they-plan-to-get-a-covid-19-vaccine-or-already-have/ The risk to the economy they could see with their own eyes, the health risks required trust in “experts”
  • 59. Biggest jump in deaths in a century!
  • 60. Between 2018 and 2020, life expectancy in the US decreased by 1.87 years (to 76.87 years), 8.5 times the average decrease in peer countries (0.22 years), widening the gap to 4.69 years. Life expectancy in the US decreased disproportionately among racial and ethnic minority groups between https://www.bmj.com/content/373/bmj.n1343 Historic Drop in Life Expectancy in the United States
  • 64. Despite overwhelming medical information about the gravity of this pandemic, some people promote resistance to mitigation efforts
  • 65. How to behave if you are a true patriot The best way to protect every one’s freedom is to oppose any effort by the government to limit your personal freedom, unless… We are in a once in a century public health crisis that threatens the health and economy of all Americans
  • 66. With smoking, information (science based) had an impact but needed government and regulatory participation to make it more expensive, illegal and inconvenient to smoke and the media cooperated in making it less sexy or desirable to smoke and cancelling tobacco advertising. There was no organized opposition to this other than the limited false advertising from big tobacco and a dwindling number of angry smokers.
  • 67. With COVID the science has been challenged almost from the beginning and there was been organized opposition to mitigation and vaccination strategies on a political basis, and government restrictions have been challenged in the courts and by state legislators. The media has been polarized as well as discredited by obvious bias and over-reach along with outrageous misinformation! Makes you wonder If the virus has a secret advocate rooting for its success!
  • 68. Authority Task Trust Government shut down cities and require masks NO Science does mitigation work/vaccines safe NO Media media provide accurate information NO Culture/Politics encourage responsible behavior NO War against COVID The villain was us!
  • 70. Survey: Misinformation affects vaccine hesitancy Tampa Bay Times June 19, 2021 - Main reasons cited were based on misinformation about the scientific facts - Most people trust advice from their personal physician - But most people no longer have a relationship with a personal physician
  • 72.
  • 74. “In God we trust…everyone else bring data!” People need more than impersonal ‘data’ they need a relationship with a health care provisor based on trust
  • 75. TRUST
  • 76. Countering antivaccination attitudes Proc Natl Acad Sci U S A. 2015 Aug 18; 112(33): 10321–10324. https://www.ncbi.nlm.nih.gov/pmc/articles/PM C4547299/ Randomized trial on the best way to deal with anti-vaccer parent who claims vaccines cause autism they tried two different approaches: Giving them new info about the harm of getting sick was most effective Confronting them about their mistaken beliefs about autism was not effective
  • 77. Does use of the expression “out of an abundance of caution…” justify ignoring science? If you’re a doctor be honest, don’t say you are following the science when you aren’t
  • 78. Is it in your best interest to behave honestly with transparency? Politician: No….they want power (stay in office and hide their sources of campaign contributions, a gaffe : accidently telling the truth) Media and Social Media: Maybe….they want ratings (conspiracy and polarization are good for ratings, some have reputations to preserve) Big Pharma: No…they want block buster drugs (whether they work or not so the least scrutiny the better) Physicians and Scientists: Hopefully Yes (if reputation, legacy and influence are more important than fame and fortune)
  • 79. Before you start pontificating or arguing with others, stop and challenge your own beliefs.
  • 80. when we ponder and speak, we often do so with the mindset of three different professions The preacher let me emphasize why I know I’m right. The prosecutor let me point out why I’m sure you’re wrong The politician, I guess we’re all right.
  • 81. To be successful think like a scientist. Treat your position as a working hypothesis that may turn out to be wrong as new information comes along, show a little humility.
  • 82. Isaac Newton Hypotheses non fingo “I do not feign hypotheses” It’s OK to say, “I don’t know.” When pushed to explain not just how gravity worked but why it worked, he said:
  • 83. Richard Feynman the physicist Richard Feynman discussing scientific integrity: “The first principle is that you must not fool yourself—and you are the easiest person to fool.” The default position in testing your hypothesis is the null hypothesis (i.e. assume you are wrong and have proved nothing) to try to avoid confirmation bias.
  • 84. How the medical experts should have presented their advice on COVID 1. It’s a new (novel) virus, but since we’re in an emergency, we will start out treating this like other Corona viruses that we know about until we have more information 2. We will start collecting reliable information by urgently setting up widespread surveillance testing and high-quality randomized trials 3. All the high-quality data will be presented in real time as it comes in and be widely shared with the public and scientific community 4. Guidelines on management will be continuously updated by expert panels with expertise in public health and infectious disease and shared widely along with the data and rationale for any changes made
  • 85. Coach: “Son, I don’t know if your problem is ignorance or apathy?” Player: “Well coach, I don’t know, and I don’t care!” Ignorance or Apathy…the public
  • 86. The public needs to feel an obligation to be educated and to keep informed.
  • 87. Like Moore’s Law Information Technology (and information) has been growing exponentially for over a century! Soon this will exceed human brain power
  • 88. Thank You for Being Late | Thomas L. Friedman We are all (almost all) now too stupid to understand what’s going on Most people are comfortable in their ignorance A few people (polymaths and scholars) are trying to keep up And Information
  • 89. 34% 13.6% 2.1% 0.13% What if you now need an IQ of at least 130 to understand nuance and complexity How best to run a democracy (100% or 16% to make decisions)
  • 90. Democracy is a pathetic belief in the collective wisdom of individual ignorance. A newspaper is a device for making the ignorant more ignorant and the crazy crazier. HL Mencken
  • 91. And finally, to consider how their behavior benefits society rather than themselves We don’t just have cognitive failure we have a spiritual failure
  • 92. Why So Many Tennis Players Don’t Want the Covid Vaccine Despite the possible consequences of not being vaccinated — illness and the loss of income and opportunity to play — tennis players have been stubbornly slow to get the vaccine. “Whether someone wants to get a vaccine or not, that’s completely up to them,” Djokovic said. “I hope that it stays that way.” New York Times / Aug. 30, 2021
  • 93.
  • 94. N X doubl es US enters WWI Depression begins US enters WWII Evidence links smoking and cancer 1964 Surgeon General Report Synar amendment Fairness doctrine on advertising Non- smokers rights Fed cig tax doubles Secondhand smoke report Broadcast ad ban Nicotine gum Master settlement agreement Family smoking protection act Fed tax increase Cig price drop FDA rule Updates Secondhand smoke report Non-smokers rights, do the vaccinated have any rights?
  • 95. Public: 1.need to be less selfish 2. work to be better informed and less credulous (or gullible) 3.Need to put pressure to force accountability and transparency from all the bad actors (media, government, industry)
  • 96. Experts (authority): the honest ones need to realize that the avalanche of new information does not automatically turn into public knowledge unless… the experts maintain (or earn) public trust (competent/unbiased/honest) and … present this new information in a format explicable (accessible) to the general public
  • 97. So, what strategy makes sense? 1. Advice for the Public 2. Advice for Experts/Authorities 3. Policy makers: appealing to the ‘good sense’ and altruism of your fellow Americans won’t get the job done (in time) , so you need to move ahead with mandates that limit access to people not vaccinated or not practicing proper mitigation strategies
  • 98. In 1905 the Supreme Court confirmed a Massachusetts law that empowered cities’ boards of health to mandate smallpox vaccination of all residents reciting the principle that individual liberty is not absolute in the face of “the common good,” and that “real liberty for all” depends on restraining individual exercises of liberty that harm others. The pre-COVID legal landscape is quite clear: a state can require vaccinations to protect public health, even imposing criminal penalties for noncompliance and vaccination as a condition of attending school or of government employment
  • 99. Sept. 2, 2021 We Work at the A.C.L.U. Here’s What We Think About Vaccine Mandates. David Cole and Daniel Mach We see no civil liberties problem with requiring Covid-19 vaccines in most circumstances. The disease is highly transmissible, serious and often lethal; the vaccines are safe and effective; and crucially there is no equally effective alternative available to protect public health. In fact, far from compromising civil liberties, vaccine mandates actually further civil liberties
  • 100. Opposed to Vaccine mandates Approve Mandates https://www.medrxiv.org /content/10.1101/2021.0 1.31.21250866v1.full.pdf Survey 15,536 adults in 13 countries How the people of various countries think about their government imposing these mandates
  • 102. How many people think we should continue to save lives? How Is this even controversial?