Since Oct. 7, about 2,500 Israeli civilians and soldiers have been murdered/killed by terrorists. Additionally, more than 22,000 Israeli soldiers and security personnel have been wounded, suffering from physical and/or psychological damage.
It’s less dramatic – but no less tragic – that since 2023, 12,000 Israelis of all ages have died from tobacco-related causes, including 900 who were non-smokers but exposed to second-hand smoke.
Hundreds of thousands have contracted debilitating diseases from smoking, including chronic obstructive pulmonary disease (COPD) that makes sufferers feel as if they are breathing underwater, cardiovascular diseases, stroke, cancer, and more. Sadly, few people are upset by this more-than-threefold toll.
While smoking is declining in many countries around the world, it is growing in Israel, rising in the last few years from one in five adults to one in four. This is due to stress from war and terror, aggressive promotion of new products by tobacco companies, lack of governmental enforcement, and ignorance among younger people that electronic cigarettes and other devices that cause them to ingest nicotine are “not smoking” when, in fact, they are no less dangerous.
Anti-smoking professionals and other activists assembled last week in the auditorium of Jerusalem’s Shaare Zedek Medical Center (SZMC) for a day-long discussion organized by the Medical Society for Smoking Prevention and Cessation of the Israel Medical Association. It was entitled “Just to Breathe.”
Dr. Ariel Rokach, director of SZMC’s respiratory care unit and the new chairman of the medical society, noted that an average of 33 people died every day and 1,000 per week from tobacco-related smoking.
“This news should have shaken the country, but it didn’t,” he said.
Graphic smoking images to appear on all relevant products
He welcomed the fact, however, that in a few months, graphic images of damage from smoking will finally appear on all relevant products. Several years ago, then-health minister Ya’acov Litzman opposed this, saying that such images would “scare children” and suggested that instead, photos of Jerusalem be printed on packets.
In two years, tobacco/smoking products will no longer have duty-free privileges in airport shops. Israel officially ratified the World Health Organization’s Framework Convention on Tobacco Control in 2005, but until now, it has ignored this prohibition.
Prof. Zvi Fried-Lender, head of the Internal Medicine D department and a senior pneumologist at Hadassah-University Medical Center, said that “Many more Israelis died from tobacco than from wars. We have failed to stop it. Tobacco companies invest huge amounts in tobacco sales and aim to sell e-cigs at kiosks as close as they can to schools.”
“All who are involved in smoking prevention and cessation are saving lives every day,” said Prof. Hagai Levine, a leading epidemiologist and head of the Israeli Association of Public Health Physicians. “Companies use manipulations to get more people to smoke; we have to prevent their aggressive marketing. We also want to get help from MKs who oppose smoking.”
Prof. Yael Bar-Ze’ev, a public health physician, behavioral scientist, and epidemiologist at the Braun School of Public Health and Community Medicine of the Hebrew University of Jerusalem, focuses on tobacco control and smoking cessation.
She said, “Smoking is not just a physical addiction, but it also involves feelings, thoughts, and attitudes. There is growing research on behavioral therapy, behavioral activation, commitment therapy, and cognitive behavioral therapy (CBT) to help people quit the habit.”
CBT, she explained, can break down the connection between thought and the desire to smoke by using mindfulness. Instead of thinking “I must have a cigarette,” one can tell oneself that “I don’t have to; I can stop it according to my ideals.” Bar-Ze’ev added that today’s cigarettes are much more addictive than they were years ago because the manufacturers add substances that cause more dependency.
Electromagnetic helmet treatment
A new smoking-cessation technology that is available in Israel is deep transcranial magnetic stimulation (Deep TMS). It is a non-invasive therapy that uses electromagnetic fields to safely stimulate targeted regions of the brain. Approved by the US Food and Drug Administration and the Health Ministry, it’s used not only for treatment-resistant major depression and obsessive-compulsive disorder but also for smoking addiction.
A patented helmet is put on the patient’s head and sends magnetic pulses directly into deeper, broader neural networks in the brain than standard TMS. This process regulates the brain’s neural activity without surgery, anesthesia, or hospitalization while the patient is fully conscious.
There are usually 20 to 36 sessions, given five days a week over a four- to six-week period. The only reported possible side effect is a mild headache at the treatment site, which usually goes away after the first few sessions.
Bar-Ze’ev said the technique has helped many heavy smokers to kick the habit. People must pay for it privately, but she hopes it will be added to the basket of health technologies in the future.
There are also advocates of psychedelic treatment using serotonin receptor agonists that regulate nerve cell communication to manage mood, anxiety, and vascular functions. They are primarily prescribed to treat migraines, depression, anxiety, and gastrointestinal issues, and have been recommended by some to help smokers quit.
But the one-time treatment has to be monitored closely, because if the patient suffers from psychiatric disease, it could cause trouble, Bar-Ze’ev stressed. “Maybe in the future, it will be a tool for smokers who don’t manage to stop with other treatments.
GLP-1 receptor agonists – medications originally developed for Type 2 diabetes that are now widely prescribed for weight management and cardiovascular health because they mimic natural gut hormones to lower blood sugar, suppress appetite, and slow digestion – have also been used to promote cessation, Bar-Ze’ev revealed.
“They apparently work in the same place where the brain affected by nicotine works. Small groups were tested who smoked fewer cigarettes and waited longer to light up when they were offered them, so it might help,” she said.
Amos Hausner, the chairman of the Council for the Prevention of Smoking, warned that “the residues of cigarettes sold today will cause deaths in 20 or 30 years in half the users, but the tobacco companies won’t be around to take care of the compensation, as in Canada, where they went bankrupt after they were found liable for tens of millions in compensation.
“Israeli tobacco users face a time bomb that awaits its turn to incubate and explode in at least half of their bodies. To provide a reimbursement, companies that sell tobacco in Israel should be required to deposit at least NIS 42 billion for the government to help the victims, just as importers of motor vehicles have to make sure there will be spare parts in the future.”
Hausner also presented two innovative proposals for the enforcement of bans on smoking in public places and the sale of cigarettes to minors: that an offender would have to participate in a course for smoking prevention, just like convicted drivers; and that a phone number must be clearly placed in public places where smoking is banned and where cigarettes are sold, for immediate complaints.
“This is similar to signs on the back of trucks that if smoke is emitted or the truck driver commits a traffic violation, thus avoiding direct confrontation between the complainant and the offender,” he said.
For heavy smokers, the primary test to detect lung cancer early is a low-dose CT (LDCT) scan. Quick and painless, the low-radiation X-ray that creates highly detailed images of the lungs to spot tumors before any symptoms appear is available free for smokers or former smokers aged 60 to 74.
Prof. Itamar Grotto, a former head of the Health Ministry’s public health department and a former associate director-general who now teaches and does research at Ben-Gurion University of the Negev in Beersheba, suggested “Forest Therapy.” He taught for a while at a school of public health in Cyprus, where he was exposed to forest activities that reduce stress.
“Fully 70% of smokers relapse because of higher stress and cognitive load. Being in the forest for a few hours and doing activities, including mindfulness sessions, can reduce stress even over time compared to a control group. It won’t work by itself, but it could help together with other treatments,” he said.
Women who smoke and drink alcohol usually go into menopause faster and have worse symptoms than non-smokers, said Dr. Avigail Ma’ayani, a gynecologist who runs smoking-cessation courses for health funds. Half of Israeli women who don’t light up are exposed to others’ smoke.
Women who smoke have a higher risk of osteoporosis, endometrial and cervical cancer, and severe COPD. They also find it harder to kick the habit than men. They usually smoke to reduce stress, while men are more hooked on the addiction.
Speakers did not have information about whether AI can help promote smoking prevention and cessation, but I asked ChatGPT for ideas.
It said that “personalized cessation coaching that tailors messages to age, stress levels, relapse patterns, motivation styles, the time of day, and triggers could help.”
AI could identify moments when someone is most vulnerable. A sophisticated future cessation system might learn a smoker’s daily rhythms, detect high-risk moments, adapt messaging style, coordinate with nicotine replacement therapy, and even identify relapse risk before the smoker consciously notices it. That’s very different from generic “Smoking is bad for you” campaigns.
Human counselors are valuable but limited in number. AI systems could provide multilingual support, 24/7 availability, culturally adapted coaching, and personalized follow-up to huge populations at relatively low cost.
Israel could actually become strong in this area because it already has advanced digital health infrastructure, strong AI, public-health expertise, and extensive healthcare data systems.”