The young guy in fatigues with the rare blood disorder wasn't irritated in the least that he'd been waiting for more than an hour for his appointment with Dr. Brad Baltz. Baltz, he said, was the best doctor in town, and a "down to earth" guy to boot. "He's got a good heart," the young man said.
Baltz, a hematologist/oncologist, proved to be exactly as his patient described him. Self-effacing and funny (he said he became a doctor because that's what his parents had in mind for him, and that if he hadn't he would have liked to have been a race car driver, but couldn't because of his "bad eyes") he is nevertheless straightforward when it comes to serious subjects. Like lung cancer, the number two killer in Arkansas after heart attack, for both men and women. (More women get breast cancer than lung cancer, but mortality is higher in lung cancer.) It is a disease that, unlike breast and colon cancer, can be virtually entirely blamed on smoking. It's a disease of our choosing, not one we can blame on genes or infection, and, Baltz said, "If the government had any backbone it would outlaw tobacco sales."
It is Baltz's experience that many people diagnosed with lung cancer will blame their disease on something other than tobacco — "they'll say I was exposed to asbestos for 15 minutes 20 years ago." Not only will they be in denial about the cause, many won't quit smoking. "I've tried everything" to get the people he sees in his office to quit tobacco, Baltz said. "I've started to tell my male patients that it causes Alzheimer's and impotence," since the threat of dying from lung cancer doesn't seem to register, something he blames on nicotine's affect on the brain. (Those who successfully quit do so "cold turkey," he said; a change in behavior that requires "a grasp on reality.")
Adding to the doctor's frustration is the fact that he is seeing an increasing number of people who never smoked, but who grew up around smokers. Their prognosis is no better than smokers'.
Because smoking is so deadly — and so preventable — Baltz takes a hard line on the tobacco master settlement, calling it a "bribe" by the tobacco companies to the states to allow them to continue to sell cigarettes. (The settlement, reached in 1998 with the four largest U.S. tobacco companies, required the companies to pay at least $206 billion over 25 years to the states.)
"If a drug killed as many people" as smoking does, Baltz said, "the FDA would try to lynch the [manufacturer] in public. ... They'd be tried as a war criminal if they marketed anything as lethal" as tobacco.
Unhappy as he is about smoking, Baltz, 48, is happy in his work. "I have the greatest job in the world," he said. He is fascinated by anemia, which he says many people think is a "boring" illness, but which manifests itself in dozens of ways. "Every patient is a puzzle," he said.