Mexico's Doctors Urged to Stub Out

No-Smoking Push Targets Physicians

MEXICO CITY -- Dr. Antonio Conde's voice comes out in a husky, smoke-cured rasp. A pack of Marlboros bulges his shirt pocket, and two more lie on his cluttered desk -- right below the "No Smoking" sign.

Conde inhales one cigarette before walking into his office at a southern Mexico City hospital. He slips out for another at breakfast and keeps puffing throughout the day, even though everything he knows about the human body tells him he shouldn't.

"If only I could give it up," the 34-year-old internist said in an interview interrupted by coughing fits. "It's a vice that is extremely hard to quit."

Conde's dilemma embodies a seldom-discussed global phenomenon. In Mexico and dozens of other countries, especially developing nations, health workers smoke at far higher rates than the general adult population. Mexican doctors and nurses smoke at twice the rate of other adults, according to international data compiled by the American Cancer Society. Similar disparities exist in Paraguay and Pakistan, countries where 32 percent of health professionals smoke, and Iranian doctors and nurses smoke at more than triple the rate of other adults.

The statistics disturb anti-tobacco activists, who worry that the habits of health professionals will influence patients and blunt the effectiveness of smoking cessation programs. Increasingly, doctors are becoming the preferred first targets of anti-smoking campaigns around the world.

Mexico has just launched a campaign that is notable for its subtlety. Instead of overtly trying to get doctors to quit, an alliance of government and private agencies, as well as the U.S. drug company Pfizer Inc., plans to lure doctors to seminars on diabetes and other illnesses, then tack on presentations about the ill effects of smoking. The program will also offer doctors Mexico's first university certification in treating tobacco illnesses.

"We're playing a trick," said Mario Acosta, head of Medical Alliance, a Mexican doctors' trade group. "You have to look for a dramatic strategy to impact them."

The goal of the campaign, which also targets teachers and students, is to reduce smoking by 10 percent in three years. Organizers plan to conduct Mexico's first large-scale courses for doctors on smoking cessation techniques.

Smoking among health professionals follows a distinct pattern, according to Thomas J. Glynn, director of international programs for the American Cancer Society. When tobacco use first becomes widespread in a country, doctors smoke more than the wider population because they generally belong to the upper classes and can afford to buy cigarettes.

"As time goes on, they give it up," Glynn said, "and that filters down to the rest of society."

In the 1950s, 50 to 60 percent of physicians in the United States smoked, Glynn said. Now, that figure has dropped to about 3 percent. Smoking rates among health professionals have plummeted similarly in Britain and Australia.

China, where more than one in four health professionals smoke, is at the opposite end of the smoking arc. Glynn said he remembers Chinese physicians lighting up during a meeting he convened about anti-smoking efforts.