My best quit-smoking aid: Philip Morris

To patients who resist, the author says: Fine, smoking-related diseases boost my income.

By James H. Mooney, MD
Internist/Ashland, OH

I never imagined that Philip Morris would play such an important role in getting my patients to quit smoking. Then again, I never thought I would be an office-based internist in rural America after my residency at a tertiary referral center, focusing on intensive care.

For both financial reasons and the desire to avoid managed care scrutiny, I chose to begin a solo practice here in Ashland, a rural stop halfway between Cleveland (where I'd trained) and Columbus. It was in Ashland that I hired my first professional financial adviser. Needless to say, my knowledge of money was about as profound as my knowledge of running a solo practice. What I didn't expect was that the adviser would provide me with my most valuable clinical tool—even though I wasn't aware of it at the time.

Meeting with the adviser reminded me of my first lecture in medical school concerning the citric acid cycle, a biochemistry favorite. I was familiar with a number of the individual components, but failed to understand the big picture. The broker flashed flow charts, P-E ratios, historical charts, and SEC filings. I asked questions, but often failed to understand the responses. In the end, I said I would simply like a portfolio centered on core companies with strong financial futures appropriate for a conservative investor. The adviser recommended Colgate-Palmolive, Microsoft, and Philip Morris.

The first two companies sounded like a good bet, but how could I live with investing in a company that caused some of the very diseases I struggle so hard to overcome? Or was I being too naive? The adviser argued that Philip Morris' diversification made it much more than a tobacco company. He quipped that I should tell my patients I enjoy a cold beer with my macaroni and cheese—from Philip Morris subsidiaries Miller Brewing and Kraft Foods.

Ultimately, my conscience would not allow it. I substituted Coca-Cola for Philip Morris, and divided $15,000 equally among the three companies.

It wasn't until almost 18 months later that I realized the profound impact of my investing decision. The revelation didn't come from Investor's Business Daily or The Wall Street Journal, but rather from an office visit with a patient—a diabetic, hypertensive 52-year-old smoker. As a 30-year-old who looks more like 20, I find it challenging to discuss behavior modification with men in their mid-40s and 50s. I usually get the "What do you know?" look, or the comment, "Wait a few years and you'll see."

But this fellow was more challenging than most. As soon as I mentioned quitting smoking, he launched a barrage of profanity toward the medical profession and me. "I'm sick and tired of this bull——!" he hollered. "All you doctors want to talk about is weight loss and smoking. If that's all you're going to tell me today, then I'm sorry I came."

Astonished, I pushed my chair back, and as I waited for him to finish his tirade, an idea popped into my head.

I looked at my patient squarely and asked, "What do I have to gain if you quit smoking?" He hesitated, so I figured I had at least caught his attention. I went on to say that as an internist married to a pulmonologist, my household income stems significantly from the consequences of tobacco abuse.

In the next 30 seconds, I reminded the guy that vascular disease, including stroke, myocardial infarction, and lower extremity claudication, along with multiple cancers of the oropharynx, lung, pancreas, and bladder, were only a few of the maladies associated with tobacco use.

I also pointed out that my office is quite busy between November and April with upper respiratory infections and bronchitis, especially in patients who smoke. I finished my brief retort with, "As a matter of fact, if it weren't for Philip Morris, I wouldn't be nearly as busy. I should buy the stock."

My patient paused and then began laughing. Realizing that my motivation was to improve his well-being, he thanked me for the response and promised he would view my encouragement differently. I had won his trust—and six months later he had stopped smoking.

I tried this approach again and have subsequently won the trust of many patients by redefining the relationship smokers have with their physician. When a patient realizes the truly altruistic nature of encouraging smoking cessation, he sees the physician as a valuable asset to overcoming perhaps the most challenging addiction.

My Philip Morris talk has produced results in my patients. Unfortunately, my Coca-Cola stock hasn't performed as well. It's down significantly since I bought it. But at least my moral imperative spared me a hefty drop in Philip Morris stock—not to mention perhaps saving some of my patients' lives.

 

James Mooney. My best quit-smoking aid: Philip Morris. Medical Economics 2002;4:82.