Mexico's Doctors Urged to Stub Out

"They told me they had other problems to worry about," Glynn said.

Physicians in Mexico -- where smoking estimates for the general population vary from the American Cancer Society's 8.8 percent to more than 20 percent in some Mexican studies -- can be equally blase about tobacco, Acosta said. Though some Mexican physicians are embarrassed about smoking, he said, others say grimly, "I've got to die of something."

The Mexican medical establishment's recent history with tobacco is a tortured one. In 2004, the country's top physician, Health Minister Julio Frenk, drew international condemnation for striking a deal with tobacco companies.

Frenk accepted a $400 million donation from the companies for new health programs but agreed to cancel the donation if cigarette taxes were raised. The deal is widely believed to have been a factor in torpedoing Frenk's promising candidacy last year to head the World Health Organization.

Frenk left office in December, and a new push for higher tobacco taxes is gaining momentum in Mexico's Congress, stoked in part by studies showing high smoking rates among Mexico's youth. More than 69 percent of Mexican smokers started using tobacco at age 12 or younger, according to a government study.

Conde, the Mexico City physician, was one of them. A cousin introduced him to cigarettes, he said, and he was smoking heavily by the time he turned 14.

After medical school, he entered an environment in which smoking among physicians was the norm. He said he remembers walking through the halls with a cigarette and smoking in his tiny office.

Slowly, the culture has been changing. Five years ago, his hospital banned indoor smoking, but physicians still cluster outside for smoke breaks. Conde now looks for inconspicuous spots outside the hospital to smoke.

"I feel embarrassed," he said.

While he chatted, a colleague in a doctor's white lab coat passed by.

"He quit 10 years ago -- when he had a heart attack," Conde confided.

Conde wants to quit, too -- without the motivation of a heart attack, he hopes. But he still smokes a pack a day.

He tried a nicotine patch, but it didn't work.

"I needed to have something in my hand, something in my mouth," he said.

Then he tried nicotine gum, but it gave him an upset stomach. Frustrated, he keeps on smoking. And he keeps on coughing.

These days, besides puffing cigarettes, he is also puffing something else: an inhaler to stop his bronchial spasms.