For Shame, Guam!

For Shame, Guam!
Samuel Friedman Hematologist-Oncologist | Hematology & Oncology Tamuning, Guam

Dr. Samuel Friedman is a hematologist oncologist practicing in Tamuning, Guam. Dr. Friedman specializes in the diagnosis, treatment and prevention of blood diseases such as anemia, hemophilia, sickle-cell disease, leukemia and lymphoma. Hematologist Oncologists are also trained in the study of cancer and its attack on... more

Uruguay is a small, democratic country on the east coast of South America atop Argentina. Unlike many of its co-continental nations, it has distinguished itself as a viable, true, stable democracy, with a high standard of living, good education and low crime rate. Now, it can be known for and proud of its winning fight against the giant tobacco industry, aka Big Tobacco.

Tobacco use by whatever route, especially cigarette smoking, is responsible for more deaths worldwide than all other causes combined, whether by cancers of various types (most all directly caused or co-factored with cigarette use), or more frequently cardiovascular disease including heart attacks and strokes. When we hear that cancer and heart disease are either the first or second cause of death in almost all countries, cigarettes are to blame. To make matters worse, it is almost always the economically disadvantaged population that are the heaviest smokers. Gone are the days when the higher economic classes smoked heavily, with these better educated people now having largely abandoned heavy smoking. Nevertheless, there will be 480,000 premature deaths in the USA this year due to smoking, and there will be $170 Billion spent on tobacco related illnesses. In the meantime, the tobacco industry will spend $9 Billion on advertisements and marketing for their killers.

Uruguay, a country of only 3.4 million people (1% of USA) and a GDP of $60 billion passed a series of laws in 2003 to reduce the consumption of cigarettes by increased taxes, curtailment of false advertising of tobacco (e.g. “light cigarettes are less dangerous”), restriction of smoking venues and education on the harms of cigarette smoking. They were sued by Philip Morris International, the largest cigarette manufacturer with an annual revenue of $78 Billion and a current work force of 80,600. The company claimed that the anti-smoking policies violated a treaty between Uruguay and Switzerland, where Philip Morris International is based. After a court battle of seven years, little Uruguay won and the tobacco bullies had to pay Uruguay their legal costs of $7 million.

Now let’s look at another small, isolated country with a terrible smoking problem, Guam. The largest population of smokers are on some sort of public assistance, making the government funds they receive complicit in the purchase of their cigarette habit, and also responsible through Medicaid and MIP or higher private insurance premiums for the horrendous medical bills they incur when they fall ill due to this habit! The Guam Government has done very little to alter this equation, begrudgingly raising the cigarette tax a small amount so cigarettes are still cheaper on Guam then most states, about $6-8 per package. To put this in perspective, a forward vision country like Australia puts the price of a package of cigarettes at a $32 or approximately US $23, enough to make smokers or potential smokers think twice about smoking. Or, at the very least, if they continue to smoke, they are paying forward through these heavy taxes for some of the increased medical expenses they are certain to incur in the future. Guam excuses for action can be blamed on apathy, ignorance, nepotism and favoritism (need I name names?), complaints by the retail sellers of tobacco, or just the usual Guam somnolence whereby so much good can be accomplished with a little legislative action, but rarely is this done. While it is said with much justification that Big Tobacco can quickly intimidate politicians and twist “right to choose” into a political divide, and promote lies like business will close, there is probable very little of this action on Guam which is too small to matter. No, this is a case of local inaction, as usual! And the problem is compounded by the dedicated smoker being near impervious to healthcare providers warnings, or all the negative publicity that smoking has had for so many decades. It is time for a meaningful government action of education at the early level, i.e., schools, and taxes on tobacco that cause more than a shrug to the smoker. How about reduced health insurance premiums for non-smokers?

If a small country like Uruguay can accomplish so much against Big Tobacco and cut their tobacco use by over 25%, surely Guam can mount the effort to shield some of its citizens from their own misdirected actions and at the same time, improve their own financial bottom line.