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Death of a fat lady
  1. SIMON CHAPMAN, Editor

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    When Jennifer Paterson, half of culinary “incorrect” British TV cookery programme “Two Fat Ladies”, recently died of lung cancer at 71, she lost eight years off the normal life expectancy of a British woman. If she started smoking at 18 years old, and smoked an average of 20 a day, she would have inhaled 387 165 cigarettes. At 12 puffs per cigarette, that is 4.65 million point blank curings of the once pristine pink linings of her lungs. With cigarettes taking an average of 5.6 minutes to smoke, she would have puffed continuously for 4.12 years. Put another way, for each cigarette she smoked, she lost nearly twice the time it took to smoke it.

    Paterson lost a 10th of the life she might have otherwise lived. She enriched lives of the viewers of her hugely popular programme for a only a short time, in what might have otherwise continued for years as one of the most rewarding periods of her life. Some commentators waved this away with the condolence that she had a good innings and lived her eccentric life to the fullest. In doing so, they reveal an interesting ageism not unrelated to a whole raft of social policy that implies older people are not really worth bothering about. Yet how would these people feel if someone offered to remove the decade of their 20s or 30s? The absurdity of such an offer contrasted with the apparent acceptability to these commentators of such an early death says much about attitudes toward the aged.

    Several years ago British conservative columnist Auberon Waugh wrote a small book, “Crash the ash: joy for the beleaguered smoker” (see Tobacco Control1995;4:198). The intent of the book was to reclaim smoking from the clutches of the health fanatics and restore it to its former glories, before all this tiresome business about it killing people got about. Not unlike the “good on her” obituaries for Jennifer Paterson, Waugh argued that smokers should be seen as heroes because they have the decency to die early: “smokers are heroes because they do . . .die, if indeed they do, on average two or three years younger. They do not then clutter up the welfare services, nor put a terrible burden on their children, nor spend everything they have to leave on nursing home fees. Longevity is becoming the great curse of western civilisation. At its worst manifestation, there are wards and wards where old people lie in semi-coma, usually on a drip, recognising nobody, understanding nothing, being turned three times a day like damp hay.”

    Photograph by Tim McPherson, reproduced by kind permission of Headline Book Publishing from Jennifer Paterson's Seasonal Receipts

    The view of the aged as decrepit, and of tobacco as a laudable, deadly pleasure that can hurry them along contrasts with the reality of aging in many countries. In Australia, for example, 19 out of 20 people aged over 65 years do not live in hospitals or nursing homes. Even in those aged over 75, the figure is still nine in 10 living in the community often in good health. Lifetime tobacco use contributes to unparalleled cardiovascular and respiratory morbidity in the aged which with the reduction in smoking is being “compressed” into fewer years of disability.

    Writing of her death, longtime tobacco control cynic and Sydney columnist Paddy McGuinness, claimed that “everyone” knows the risks of smoking which have been “adequately conveyed” to the public and that the tobacco industry did not knowingly conspire to addict, harm, or kill people. I wonder if Jennifer Paterson had the remotest idea that she had a fourfold risk over non-smokers of going blind? Or that one in two smokers will die from a tobacco caused disease, on average 12 years early, meaning that the average smoker will lose six years of life? Or that more than 80% of people first diagnosed with lung cancer will be dead within five years, one of the worst prognoses for any disease? How informed was her “choice” to smoke or how much was it a lifetime of stoking her body's need for the next nicotine fix?

    Jennifer Paterson perhaps sensibly told her surgeon to disappear when he suggested she quit after her diagnosis. What would have been the point when she was to die weeks later? The widespread mythologising of her smoking as another welcomed nail in the coffin of political correctness will warm the hearts of the tobacco industry. Too bad though, for the millions of more anonymous victims around the world whose similar bleak demise each year passes unsung.