Jeong Gi-seok, the director of the National Health Insurance Service, holds a press conference on the afternoon of the 22nd at the Seoul High Court in Seocho-gu, Seoul, ahead of the final arguments (12th) in the tobacco lawsuit appeal. /News1

Cigarettes are a cause of diseases, including lung cancer. Tobacco companies must be held accountable.

Jung Gi-seok, chairman of the National Health Insurance Service (NHIS) and a specialist in respiratory medicine, noted on the afternoon of the 22nd during the final arguments of the second trial for a 53.3 billion won damages lawsuit against tobacco companies that since citizens have developed lung and laryngeal cancer due to smoking, tobacco companies should be held accountable.

Chairman Jung stated, "I have seen countless patients secretly smoking in hospital corridors before surgery," and added, "Due to the addictive nature of tobacco, patients continue to smoke even though they have only one body before the surgery." He further emphasized, "Lung cancer cannot occur without tobacco," saying, "Various academic societies also support the causal relationship between tobacco and lung cancer."

The scene of the tobacco sales stand at a convenience store in Seoul on the morning of the 21st. /Yonhap News

◇The medical community supports the NHIS tobacco lawsuit statement

The NHIS filed a damages lawsuit against tobacco companies KT&G, Philip Morris Korea, and BAT Korea in April 2014. They are demanding the return of the medical expenses incurred by the NHIS treating 3,465 patients who were diagnosed with lung and laryngeal cancer from 2003 to 2012.

The first instance ruled in favor of the tobacco companies, stating that it is possible that cancer developed not only due to smoking but also due to family history, personal habits, surrounding environment, or other factors. The NHIS appealed, and the case moved to the second trial.

The medical community has been consistently issuing statements supporting the NHIS tobacco lawsuit. The Korean Society for Smoking Cessation stated, "The health damages caused by tobacco are not an individual issue, but a societal problem," asserting that "the medical expenses resulting from cancer caused by smoking are burdening the finances of the NHIS." They pointed out that since treatment costs come from the NHIS, ultimately, citizens are bearing the burden.

The Korean Lung Cancer Society also commented, "Smoking is the most direct and critical cause of lung cancer," adding, "Smoking not only causes lung cancer but also affects the progression rate and severity." The Korean Association for the Study of Liver Diseases claimed, "Smoking is a cause of lung and laryngeal cancers," stating that "tobacco companies have minimized or concealed product addiction and harm while failing to provide adequate warnings."

Graphic=Jeong Seo-hee

◇The NHIS submits research results indicating lung cancer causation

The NHIS has newly submitted research results indicating that smoking increases the risk of lung cancer to the 6-1 Civil Division of the Seoul High Court (presided over by Judge Park Hae-bin). The study revealed that smokers who have smoked for over 30 years or those who have smoked a pack a day for more than 20 years are 54 times more likely to develop small cell lung cancer compared to non-smokers. The risk for squamous cell lung cancer was found to be 21.37 times higher, and for squamous cell laryngeal cancer, it was 8.3 times higher.

In contrast, the risk level of cancer caused by genetic factors was only 1.2 to 1.8 times different. It suggests that smoking status and duration significantly influence cancer onset compared to family history. This conclusion is based on an analysis of health examination data, cancer registration data, and genetic risk scores (PRS) from over 136,900 individuals by the NHIS Health Insurance Research Institute and Yonsei University's College of Public Health.

Previously, when the NHIS filed the lawsuit, tobacco companies countered that the NHIS lacked standing. While patients diagnosed with cancer due to smoking can file lawsuits, they argued that it is difficult to accept that the NHIS can file one. The NHIS asserted that it is qualified to do so under the National Health Insurance Act as it manages insurance benefits (medical expenses).

The Seoul Central District Court's 22nd Civil Division (presided over by Judge Hong Ki-chan) determined in November 2020 that the NHIS has standing to file the lawsuit; however, it would be difficult to acknowledge a direct causal relationship between smoking and cancer. The second trial court concluded the final arguments on the same day and will set a date for the verdict. This will result in the final conclusion of the tobacco lawsuit that has been ongoing for 11 years. It remains uncertain whether the second trial court will overturn the first instance and side with the NHIS. Supreme Court precedent holds that if someone develops a disease from smoking, it is the smoker's responsibility.