Clínica para el Tratamiento del Tabaquismo, Facultad de Medicina, UNAM, México, DF, México.
Salud Publica Mex. 2010;52 Suppl 2:S366-72. doi: 10.1590/s0036-36342010000800035.
Despite of the accumulation of scientific evidence confirming the health consequences of smoking and the new paradigm of smoking as a disease where nicotine is the drug that modifies the functional and morphological characteristics of the brain in dependent smokers, tobacco smoking continues as an important public health problem in many Latin American countries. In contrast with big advances in the tobacco control area, as an example the Framework Convention on Tobacco Control signed by 168 countries, the role of health professional in the fight against tobacco is still less than ideal. In many Latin American schools of medicine, deficiencies in medical education has led to insecure physicians when they have to motivate their patients to stop smoking or to prevent young people to begin tobacco consumption. If each general practitioner or specialist during their daily medical assistance could talk to their smoker patients about the big benefits of stop smoking and support them to get free of tobacco, we would be winning a battle against smoking. Also if we could achieve generations of young non smoking doctors, who could be a real example for patients, this could also impact the prevalence of smokers. In this article we analyze the neurobiological bases of nicotine addiction, which we think are missing in the medical curriculum and could help doctors to understand tobacco smoking as a disease rather than a risk factor, and discuss the main reasons supporting an urgent change in the medical approach of tobacco cessation in Latin America as well as the need to actualize the medical curriculum in order to give physicians the skills needed to intervene successfully with their smoker patients and to be themselves non smokers.
尽管有大量科学证据证实了吸烟对健康的影响,并且新的模式将吸烟视为一种疾病,尼古丁是改变依赖吸烟者大脑功能和形态特征的药物,但在许多拉丁美洲国家,吸烟仍然是一个重要的公共卫生问题。与烟草控制领域的重大进展形成对比的是,例如有 168 个国家签署的《烟草控制框架公约》,但卫生专业人员在与烟草作斗争中的作用仍不尽如人意。在许多拉丁美洲的医学院校,医学教育的缺陷导致医生在试图劝说患者戒烟或防止年轻人开始吸烟时缺乏信心。如果每位全科医生或专科医生在日常医疗援助中都能与他们的吸烟患者谈论戒烟的巨大好处,并为他们提供戒烟支持,我们将赢得与吸烟的斗争。如果我们能够培养出一代不吸烟的年轻医生,他们可以成为患者的榜样,这也可能会影响吸烟者的比例。本文分析了尼古丁成瘾的神经生物学基础,我们认为这些基础在医学课程中有所缺失,这有助于医生将吸烟视为一种疾病,而不是一种风险因素,并讨论了在拉丁美洲紧急改变烟草戒断医疗方法的主要原因,以及需要实现医学课程的实际化,以便为医生提供成功干预吸烟患者所需的技能,并使他们自己也不吸烟。