By Ronald M. Davis, MD

This column was originally published in AMA eVoice on July 12, 2007. Dr. Davis is president of the American Medical Association.

View ad (PDF, 212KB)

You might have seen this colorful ad in the newspaper last week. Financed in part by the AMA, the ad is sponsored by Americans for Children's Health, a new coalition calling for congressional reauthorization of the State Children's Health Insurance Program (SCHIP)—a successful public program that covers more than 6 million children whose parents can't afford coverage.

Millions of children like these, on playgrounds across the country, are seriously at risk because they have no health insurance. That's why last month the AMA approved policies that would improve, adequately fund, and raise enrollment of SCHIP—a valuable safety net of care for America's children. It's because of SCHIP that millions of kids can see the doctor when they're sick and get routine check-ups, hearing and vision screenings, and prescription drugs, so it's critical that this important program be reauthorized.

The problem is that lawmakers have yet to decide how to pay for the 8 to 9 million children the program will protect, including the 2 million who currently are eligible for SCHIP but not enrolled. The solution? Raising federal tobacco taxes, a move the AMA and more than 60 diverse stakeholders in health care are urging Congress to make.

Considering what we know about the dangers of smoking, this makes perfect sense. Smoking remains the No. 1 preventable cause of death in the U.S., killing roughly 1,200 Americans every day. Each year tobacco use is responsible for almost $90 billion in U.S. health care expenditures. Every day, 4,000 children start smoking—and 1,500 become daily smokers. Meanwhile, studies show that for every 10 percent increase in the price of cigarettes, youth smoking is reduced by 7 percent, and overall consumption by 4 percent. A tobacco tax increase would act as a deterrent to both young and potential smokers.

The facts are clear—higher tobacco taxes equal lower smoking rates in the long run, and the effect is greater among America's kids. The higher the tax, the more substantial the future public health benefit. And fewer smokers means fewer people with strokes, heart attacks, cancer, and other smoking-related health conditions.

A decade has passed since Congress last voted to raise the federal cigarette tax, so it's high time for lawmakers to do so again. Increasing the tobacco tax and putting that money directly into health care for children is a win-win proposal that would better protect Americans—and it's a sound investment in our nation's future.

And just in case any members of Congress worry about the politics of supporting higher taxes, the results of a recent public opinion poll (PDF, 216KB) conducted by the Mellman Group for the Campaign for Tobacco-Free Kids should provide comfort. It showed that 67 percent of voters favor a 75-cent per pack increase in the federal cigarette tax, with the revenue dedicated to providing health care coverage for uninsured children; only 28 percent are opposed. Moreover, support is strong across party lines and all sociodemographic groups (according to age, gender, race, income, and educational attainment, and those in urban, suburban, and rural communities). Lastly, sizeable majorities of Democrats, independents, and Republicans (as well as "conservative Republicans") would vote for a hypothetical candidate who supports a tobacco tax increase over a candidate who opposes it.

The lighter side
The staff of Aesculapius vs. the caduceus of Hermes

Two symbols are commonly used to represent health and medicine—the staff of Aesculapius (one snake around the staff and no wings) and the caduceus of Hermes (two snakes and a pair of wings). Aesculapius was the Greek god of medicine and healing. Hermes, on the other hand, was the deity of wealth and commerce, and was revered by some as the patron of thieves. Thus, the caduceus should not be used by those dedicated to preventing disease, treating illness, and relieving pain and suffering.

The staff of Aesculapius has long been part of the AMA's logo, and a modern version of it graces the AMA's current logo. I urge all health-related organizations, institutions, and businesses that use the caduceus as a corporate accoutrement to switch to the staff of Aesculapius. Those wishing to read more about these competing symbols can begin with the references I've listed below.

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On the way to the World Medical Association's General Assembly meeting in South Africa last October, my wife and I stopped in Tanzania for a six-day safari on the Serengeti. The beauty of the country, the splendor of the animals and the warmth of the people made this trip an unforgettable experience. But it was unique for another reason—I discovered that the staff of Aesculapius is on the country's 500-shilling note.

I have tried to find out how and why the staff of Aesculapius found its way onto the currency of Tanzania, but my queries to the country's currency department and Ministry of Health and Social Welfare have gone unanswered. So I have two questions for readers of eVoice:

• Do you know how and why the staff of Aesculapius became part of the currency of Tanzania? I will send a brand new 500-shilling Tanzanian note to the first person who provides the answer.

• Do you have any other examples of unusual appearances of the staff of Aesculapius? If so, please share them with me, along with photos and details as appropriate. Depending on what I receive, I may devote a future column to those examples.

Please send replies to evoice@ama-assn.org.

Selected references

Ghimire LV. Snakes and staffs. studentBMJ 2005;13:221-264.

Blayney K. The Caduceus vs the Staff of Asclepius (Asklepian) [revised October 2005].

The symbol for a new AMA: medicine for the 21st century (editorial). American Medical News, June 20, 2005.

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