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By K-O Haustein, Springer-Verlag, 2002, 446 pages, US $99, ISBN: 3540440313 (translated from the German original)
Tobacco or health?
Writing a single volume on the most researched topic in biomedical history is no small undertaking. Numerous volumes on specific disease consequences of smoking have been published by medical authors from around the world. But I know of no comprehensive review that does as thorough a job as this book. In 14 central chapters, the author thoroughly reviews the literature on a wide and growing list of subjects related to tobacco use and its consequences. Though the author is clearly aiming the book at clinicians and medically literate readers, the directness of the content with plentiful figures and tables helps to keep the sections in each chapter concise.
The author clearly has a pharmacological background and the text is sponsored by Pharmacia, makers of Nicorette. Though chapters 4, 10, and 11 reflect this emphasis, there is sufficient content in all areas with recent journal findings plentiful. A massive seventh chapter entitled “Other organ systems” is a unique mix covering everything from psychiatry to psoriasis. The book contains over 2400 references covering both tobacco’s role in disease and immediate preventive challenges: providing smoking cessation, addressing secondhand smoke, and predatory tobacco industry marketing.
Appealing features are the book’s thoroughness and forward research focus, with particularly strong chapters on the pharmacology of nicotine dependence and secondhand smoke. Because the book is so evidence oriented, it covers certain social aspects of tobacco control only very briefly. Summary points at the ends of each chapter are useful but often too prescriptive, providing little insight to the varied contextual factors which make the social dynamics of tobacco control issues so difficult.
I must admit, I even enjoyed the clear annoyance that the German author expresses in his last chapter towards European politicians, tobacco industry research funding, subsidisation of tobacco growing, tobacco constituent regulations, tobacco taxing policies, lack of tobacco advertising regulations, and the tobacco industry’s misinformation campaigns on the consequences of smoking. Others may find these comments too subjective. Nonetheless, the author does make his point; there is a lot of awakening necessary to speed the present slow pace of tobacco control measures in Europe.
Overall, I rate this book not only a useful introduction to various medical research findings, but an important challenge to physicians to address tobacco as a drug product. Thus far, research and the use and abuse of tobacco have been largely controlled by the tobacco industry. This is reminiscent of the early days of limited “patent” drug regulation in the USA by the Food and Drug Administration. While withholding biomedical findings from the public is one aspect of the fraud of the tobacco industry, product manipulation and misrepresentation alone would seem to warrant stronger regulation given the resulting toll documented here. This book makes it clear that the science of tobacco as a drug can no longer be left to the industry and stresses many emerging issues that scientists and physicians must soon address. The message is that health is the social option the world should no longer forgo and, as the evidence suggests, must act upon now.
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