Can you imagine C. Everett Koop, surgeon general of the United States between 1982 and 1989, refusing to take a stand on the question of smoking? Something like that happened in Hungary the other day when István Éger, president of the Hungarian Medical Association, refused to take sides on the question of whether it is ethical for a physician to own a tobacconist shop or shops. He claimed that “the question is too controversial.” He explained that, after all, owning a tobacconist shop “doesn’t mean that the physician will be sitting at the cash register.” So, according to the author of the article that appeared in Index, “the Hungarian Medical Association doesn’t consider it inappropriate for a physician to profit from selling a product that can have devastating effects on his patients’ health.” By way of explanation Éger said the following, which the reporter found incomprehensible. “A healthy lifestyle is an important part of everybody’s life and Hungary is a pioneer in limiting tobacco use. It would be best for everybody if there were no tobacconist shops at all, but since that is not the case, we don’t want to take sides.”
I will try to shed some light on what might be behind the very cautious, perhaps even cowardly stance of the Hungarian Medical Association. First of all, quite a few physicians and their relatives won twenty-year concessions for tobacconist shops. By now it is an open secret that local Fidesz politicians decided who would have the opportunity to operate a National Tobacconist Shop. The decision was based primarily on whether the applicant was a Fidesz supporter. And the percentage of Fidesz supporters within the medical community is extraordinary high. I might point out that traditionally the medical profession has been attracted to the political right. One mustn’t forget that the idea of the notorious numerus clausus was hatched at the medical school of Budapest in 1920.
Some of the doctors who received permission to operate tobacconist shops are rather important political actors within the medical profession. Most likely they would have raised hell with Éger had he taken a stronger stand. As it is, Éger’s position at the moment is rather shaky.
And finally, my hunch is that far too many physicians still smoke. The huge debate about smoking that occurred in the U.S. in the 1970s has not yet been settled in Hungary.
It is true that smoking has decreased somewhat among men in the last ten years or so, but the number of women smokers has risen by 1% every year. I might add here that getting reliable and detailed data on smoking in Hungary is rather difficult. One problem when it comes to comparing data, let’s say, between Hungary and the United States is that while the U.S. numbers refer to the population of 18 years and over, most Hungarian data I found talked about smokers age 15 and over! According to a fairly recent summary published by the National Public Health and Medical Officer Service (ÁNTSZ), since 2009 the number of male smokers under 65 decreased by 2% but among those over 65 it grew by 2%. In any case, the percentage of smokers in the 15+ population is very high. It is noteworthy that Hungary has the highest death rate due to lung cancer of any country in the world.
I tried to find data on the percentage of smokers among Hungarian physicians, to no avail. In fact, no such data exist according to The Tobacco Atlas. But here are a few European statistics that are available. In France 34.6% of physicians smoke, in Poland 76.8%, in Ukraine 33.1%, in Germany 27.5%. The number in the United States is 3.3% and in Canada 6.0%. Let’s assume, extrapolating from these figures, that perhaps a third of all Hungarian doctors smoke. This figure would match the smoking habits of Americans who didn’t even finish high school. And we know that normally there is a high correlation between educational attainment and smoking.
Naturally I find it appalling that Hungarian doctors can have a handsome second income stream selling tobacco products. One might counter that Hungarian doctors are very poorly paid and therefore one mustn’t be very surprised that they grabbed at this business opportunity. But I found at least two obstetricians among the recipients. Obstetrics is the most lucrative medical specialty in Hungary. A childbirth, theoretically free, usually costs $400-500. This money goes straight into the doctor’s pocket, hidden from the prying eyes of the tax man. If estimates are correct, the tobacco shops (which seem to be expanding in the direction of convenience stores) will be equally profitable if not more so. And, after all, business is business.