This will be my last Comment as your president. During this past year I have talked about many areas of interest including public transit, keeping patients healthy, and physician physical activity. Before I sign off, there are two additional issues that I would like to highlight--the incredible health toll of smoking in our current population and the ensuing environmental destruction that if unchecked will diminish the health of future generations.

We have organic vegetables, organic meats, even organic wine on the market these days. But I have yet to see demands for organic tobacco. I say this tongue in cheek because those who choose to pick up a cigarette and begin to smoke accept that they are taking a big risk. We all know that nicotine, which occurs naturally in the tobacco plant, causes havoc with dopamine and other neurotransmitters in the brain, and is highly addictive. As well, hundreds of chemical additives in every cigarette form more than 4000 chemical compounds--of which at least 250 are harmful, including about 70 that can cause cancer.

These facts are ignored because the act of starting to smoke is an act of bravado built into our makeup. Jared Diamond, a well-regarded geographer, evolutionary biologist, and physiologist, outlines this phenomenon in his book The Third Chimpanzee: The Evolution and Future of the Human Animal. He equates those who begin smoking to antelopes jumping up and down when cornered by a lion as they try to appear larger and fiercer to their predator, when keeping their feet on the ground and running away fast would offer the best chance of survival. He states that there must be a built-in instinct for a similar act of bravado among species that on the surface appears foolish but to the subject is contributing to its survival. This would appear to hold true to the individual antelope caught by the lion or to the cancer sufferer who began smoking and was later unable to stop.

Our declining environment concerns me greatly. When walking and running in many neighborhoods, I see on the roadways discarded materials from cigarette packs—boxes, wrappers, and butts. I consider the detrimental effect this has on the environment, and I wonder why it is so difficult for smokers to deposit these in ashtrays and garbage containers. If we set aside the personal harm of smoking we can better understand the concern for the environment.

As a society we must support community projects and commercial ventures that are committed to reducing, reusing, and recycling. Within health care there have been efforts by many groups to enhance green hospital policies and the greening of physicians’ offices. The BCMA’s Environmental Health Committee has for decades worked to minimize environmental toxicity and degradation by lobbying government to regulate uranium mining. The committee also worked with government on safe drinking water regulations and, more recently, to improve existing sewage disposal regulations. Physicians can be very effective in making and supporting recommendations related to the environment. The Council on Health Promotion and its Environmental Health subcommittee will need committed physicians to do just that. If interested, please contact the BCMA.

I am concerned for our future, and our children’s future. Jared Diamond also wrote Collapse: How Societies Choose to Fail or Succeed in which he outlines how earlier successful civilizations self-destructed due to great environmental fragility. I hope that with our available wisdom on the importance of our environment and grasp of history we can avoid repeating a similar collapse.

—Bill Mackie, MD
BCMA President