Fifty years ago, I asked my radiologist father why many of my grade school friends shunned another who had asthma. “Well, David,” he responded, “most people, and many physicians, believe that a psychiatric disorder or a personality flaw causes asthma, even though the scientific evidence does not support that.”
Last summer, while presenting “Medical Management of Tobacco Dependence” at the house-staff noon conference at Stanford Medical, I related this story. Their eyes popped. Jaws dropped. They were astounded that 50 years ago anyone could have thought asthma was a psychiatric disease. After they recovered from their shock, I said I hoped that 20 years hence no one would believe the use of cigarettes was a manifestation of a flaw in character or a weak will. Rather, everybody—physicians and nonphysicians—would approach tobacco dependence for the chronic medical disease it is, and recognizing cigarette use as the primary symptom of tobacco dependence.