Philippe Boucher's Rendez-vous with . . . Arthur Pitchenik MD
Rendez-vous with . . . Arthur Pitchenik MD
About the video "They're Rich, You're Dead"
Chief of the Pulmonary section at the VA Medical Center
Miami, Florida, USA
Arthurpit@aol.com
By Philippe Boucher
Rendez-vous 136
Monday, April 29 2002
PB : Thank you Arthur for accepting our rendez-vous.
May I ask you to introduce yourself ?
Arthur Pitchenik: I'm currently chief of the Pulmonary section at the VA Medical Center in Miami and Professor of Medicine at The University of Miami School of Medicine. I graduated University of Virginia Medical School in 1962; Internship at Kings County hospital in Brooklyn; Residency at Los Angeles VA Hospital; and Pulmonary training at The Brompton Hospital in London, England.
Q1. Can you explain when and why you decided to produce the video "They' re Rich, You're Dead"? How you put it together?
Arthur Pitchenik: I produced the Video " They're Rich, You're Dead " in 1995 with my son Ari who at the time was a student video editor in college. It's purpose was and is to prevent adolescent youths from smoking. The video takes youths on hospital rounds and shows them what we see EVERY DAY in our patients with end stage smoking related diseases. The video also explains to them how smoking caused these diseases. All of the patients volunteered to appear in the video despite their extreme illness in the hope of preventing youths from making the same mistake they did, at about the same age they did and for the same reasons they did (e.g. starting to smoke, " no big deal " ) To make the message more relevant to teens, we included teens who were already tobacco addicts and willing to provide testimony of what this means! We also wanted to generate social outrage from youths on how tobacco companies through promotions and ads have targeted and manipulated them into buying their addicting poison---hence the title "They're Rich, You're Dead".
Q2. The famous New Orleans surgeon Alton Ochsner was summoned in 1919, while he was a third year student in Medical school to observe a lung cancer surgery then considered so rare that he was told he might never see another in his career. You write that you want the video viewers to see what you see in your hospital everyday, to witness the suffering... Can you expand on those daily experiences and how you react to them?
Arthur Pitchenik: As a pulmonologist, the most common patients I see are those with lung cancer, chronic bronchitis and emphysema ( COPD). In the VA hospital, as elsewhere, these diseases are epidemic. Lung cancer is the most common cause of cancer death in both men and women and COPD is the most common chronic disease that a pulmonologist treats. I can't count the times I've faced a patient's lung cancer "eyeball to eyeball" thru a bronchoscope or watched an emphysema patient die on a ventilator. Both diseases are responsible for a huge amount of personal and family suffering, do not have effective treatment and are almost completely preventable if a person does not smoke. This is very frustrating to me, especially when I drive home and see kids lighting up by a mall or school without a clue of what they're getting into. Like Mr. Thornton (the patient in the video who died from cancer of the tongue) said to me when I asked him why kids smoke, "They know but they don't REALLY know!"
Q3. The images in the video are quite strong. What reactions do they elicit from the audience? How old do you think the viewers should be? How do the young smokers react? There are no women patients. Does this absence bring questions?
Arthur Pitchenik: The video is meant for adolescents in high school and middle school, especially early middle school before they start to smoke and become addicted to nicotine. Getting tobacco addicts to stop ( including tobacco addicted kids) is extremely difficult. Adolescents do react strongly to the graphic nature of the video but in exit surveys of thousands of middle school and high school students who saw the video, over 90%, "agreed or strongly agreed" that it was effective in teaching them something they didn't know about tobacco use and that it was effective in convincing them not to smoke. Their most common comment is " gross, but effective". Although a few cover their eyes at certain parts, they soon uncover them and no one falls asleep. Curiously, we have observed that kids often react more positively to the video and less horrified than adults. Nevertheless, I have not yet received one complaint from a parent. I have received hundreds of letters, almost all of them positive, from kids who were exposed to our program. Here's one from a 6th grader that addresses your question:
" Many people might of thought that your vedio was disgusting and didn't like it! Others might lie and say it was interesting! Well I'll tell you the truth! I did think some parts were strong but I did like it! You got me attracted and thinking! I think that was your goal and with me you've reached it! No I have not smoked and will never smoked. My one and only suggestion is to never give up on what your doing! It's a good thing and good things don't go bad! My grandfathers smoke and now its to late to stop them but one thing you have stoped is the continuation of smokeing in MY family!!!!
There are no women patients in the video because the patients came from a VA hospital in which almost all patients are male. This absence does raise audience questions but we explain the reason and stress the point that pack for pack, women are just as susceptible to smoking related diseases as men and there is even recent evidence that they may be more susceptible then men to lung cancer and emphysema.
Q4. You mention at the end services the smokers can contact to get help quitting. Do you think those services are adequate to help young smokers? Does the video convey the message that quitting is possible (although many adolescents express the strength of their addiction)?
Arthur Pitchenik: When our medical students field class questions after they have shown the video, they are instructed to raise the subject of quitting and are provided with information to address this question. We also refer kids who smoke and want to quit to the local American Lung Association who have a smoking cessation program for kids called "NOT". Most of the kids we present to in middle schools, however, have not yet started to smoke and their questions about help with quitting are usually for their parents who smoke. They get scared for their parents after they see the video. We inform them that quitting, although hard, is definitely possible especially with help. Kids who don't smoke (the great majority who we address) must however be told the truth, that nicotine addiction is very powerful and quitting is very hard!
Q5. All the pain the video shows is still constantly buried under the ever-present smiling and alluring tobacco ads and promotions. Is there progress? At one point smoking prevalence did fall in Florida but tobacco control credits have been cut down. How is your medical school community program doing in this context? Has the tobacco-free Miami-Dade community partnership -that funded the copy of the video- been affected by the cuts?
Arthur Pitchenik: The tobacco companies do whatever it takes to reach their target consumer groups whether its targeting Hispanic and Asian women who have a currently low prevalence of smoking and therefore represent a huge potential market here and especially abroad or targeting youths which the US government now says are "hands off." The Phillip Morris "smoking prevention" TV spots targeting youth under the guise of being "responsible" are, in my opinion, purposefully ineffective and nerdy and nothing like the effective Truth campaign TV spots. Ask any kid! I recently saw a "responsible" tobacco company sign in a Seven-Eleven convenience store which read " Come of age, its the law " as if smoking represents a rite of passage to adulthood. Tobacco companies speak with a double tongue. The state of Florida sign right next to it read "Proof of age----" ) Taking down the tobacco billboard ads does prevent some targeting of youth but this is not near enough.
Our medical school program has not been affected by the recent drastic state cuts in tobacco prevention funding, since it was never dependent on these funds in the first place. We initially developed our Videos, CD ROMS and Workbooks largely thru a massive volunteer community effort including much help from my own kids who are into the Arts. Our Community Program has now been integrated into the regular UM Medical School curriculum in which all 3rd year students participate, and is coordinated by myself, on a voluntary basis, with the help of the Primary Care Medical School Office. I think that the Miami-Dade Community Partnership however, who did help us with some funds in the past, has been hard hit by the cuts and will have difficulty maintaining the comprehensiveness of their excellent program. Its like cutting funds to a cancer vaccine!
Q6. Is there anything else you would like to add?
Arthur Pitchenik: We hope that our Medical School Tobacco Prevention Program targeting Community Youth can serve as a model for other Health Professional Schools and that our Video and Interactive CD ROMS which we use to implement it can be shared with others as a community service. Toward this end, copies of the "THEY'RE RICH, YOU'RE DEAD" Videos and CD ROMS can be obtained at copying cost by contacting our fulfillment company. ( In USA call 1-800-654-5765 ; outside the USA e-mail: tapeorders@accordvideo.com ) As many additional copies as are needed may be made using local facilities, if this is more convenient, provided that the material continues to be used for non-profit public service and is not edited.
The Videos, CD ROMS and Workbooks can also be viewed on our website www.mededu.miami/Tobacco (with a fast internet connection). I hope you will check them out, even if its just to see a 66 year old Jewish physician RAP his own antismoking RAP Song badly ( CD ROM-2 ).
PB: Thank you Arthur for taking the time to be with us today.
Rendez-vous is supported by a contract from the Robert Wood Johnson Foundation
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