I trust you have all heard it--lung cancer and emphysema, and the little box that warns you that cigarettes "may be hazardous to your health." However, what the majority of people do not realize, however, is that there is a great deal more to it than that. As a physician working in both a clinic and an hospital emergency department, I have come to realize that smoking and other forms of tobacco are, for all the public awareness coming to light now, still one of the greatest underestimated social hazards today. I further believe that this is because of an active campaign to keep true awareness of the problem from the public.
Tobacco is running neck-and-neck with obesity as the number one preventable cause of death in my country. While obesity is a complex issue, given that one cannot give up eating, the solution to tobacco dependancy is fairly straightforward--do what it takes to break the addiction. I am pleased to see a series of commericals bringing the truth of the matter to light; Truth.com has hosted a series of performance art demonstrations portraying motherless children, large stacks of body bags, and other startling images, paired with statistics directly relating these to the damage done by the tobacco industry.
Tobacco causes more than lung cancer and emphysema. It is directly linked to other forms of cancer; in fact, it contributes to nearly all forms of cancer. Tobacco has been implicated in transitional cell carcinoma of the bladder. An oncologist from M.D. Anderson in Houston explained to me that he still advises patients to quit smoking even if they already have lung cancer, because the nicotine interferes with radiation treatments and chemotherapy. Nicotine constricts small blood vessels, in effect creating a chronic disease that predisposes one to significantly increased risk of heart attack and stroke, leading causes of death and disability in my country respectively.
Tobacco worsens chronic pain. I see an inordinate number of people suffering from chronic low back pain or migraine headaches. People who smoke are less able to recover from injuries and are more likely to have chronic pain afterwards, and are more prone to having worse pain. The association is so strong, in fact, that the better neurosurgeons and orthopedists insist that patients undergoing surgery for neck or low back disc problems stop smoking at least two weeks before surgery and hold off at least for two weeks after if they cannot give it up altogether. Some of them do not operate on smokers at all. The difference in surgical outcome is so important that I even advise non-smokers at times to see whether or not the surgeon asks about smoking as one way to get an idea of how good the surgeon is. In southeast Texas where I work, there are a large number of former industrial workers on disability due to chronic low back pain, resulting from a combination of an inevitable work-related injury and the inability to heal properly.
Tobacco contributes to anxiety, the leading psychiatric and emotional complaint I see. People smoke to relax, but they are in the process taking in a stimulant that ultimately is causing them to become more anxious. The simultaneous psychological association with relaxation and physical aggitation creates a postive feedback loop that ultimately creates one of the worst drug addictions known. I have honestly been told by reformed addicts that quitting heroin was easier than quitting smoking.
Parents who smoke are a leading health hazard to their children. Kids in smoking households have a significantly greater incidence of asthma and upper respiratory infections, and are more frequent visitors to the emergency room. Children born of women who smoke during pregnancy are more prone to being sickly and having delayed development, both physically and mentally, in part because of the constriction of blood vessels supplying the placenta, in effect starving the fetus.
Second-hand smoke also affects other people. Airline flight attendants recently won a sizable class-action lawsuit in the United States because of a significantly elevated incidence of lung cancer in people exposed to the toxins on a prolonged basis. (Thankfully smoking is no longer allowed on American flights.) A World Health Organization study recently described the full extent of incidence of cancer caused by second-hand smoke, verifying that smokers are living, walking health hazards.
Getting back to lung cancer and emphysema, most people do not realize just how much of an association there really is between smoking and these diseases. In roughly one half of all people who smoke at least a pack a day for ten years, between one and three regions of carcinoma in situ exist--cancer that simply has not yet spread. This statistic is based on autopsies of people who died from other reasons; the cancer was an incidental finding, but had the potential to kill further down the road. After two packs a day for ten years or one pack a day for twenty years, the incidence climbs to 80%. Chronic obstructive pulmonary disease is something I see daily; nearly all of the people with it are smokers, except for a few with a rare disorder known as alpha one antitrypsin deficiency. I am convinced that were it not for smoking, emphysema might be considered an uncommon disorder, perhaps next to myasthenia gravis in the medical textbooks.
Smoking damages quality of life in many other arenas. Just as it destroys the ciliated lining of the bronchi that protect the lungs, it also destroys the sense organs of taste and smell. Thankfully, these are among the first structures regenerated in newly converted nonsmokers; people who quit smoking report substantial improvement in the taste of food and the sense of smell. They then go on to report just how putrid the smell of cigarettes and smokers are.
This next paragraph is for the young ladies. Tobacco ages people prematurely. The altered blood flow to the skin leads to earlier wrinkles. Nicotine is a greater cause of tooth rot than foods high in sugar; I have never seen so many people under the age of forty wearing dentures until I moved to southeast Texas, where so many people are industrial workers who smoke heavily. Nicotine also alters the voice over time, causing it to sound increasingly course, deep, and scratchy. Quite frequently, the people who look young for their age are nonsmokers, while those who look old for their age are smokers.
Smoking is a fire hazard; cigarette butts are a frequent cause of loss of homes as well as forest fires. The presence of cigarette smoke also lowers property value. Personal health insurance rates are higher in smokers for obvious reasons.
I am an American, and it is an unfortunate truth that the tobacco industry has infected my government. Were cigarettes introduced today to an otherwise identical government free of their influence, tobacco would almost certainly be classified a controlled substance. At the very least, cigarettes would not be allowed past my country's Food and Drug Administration, whose function it is to evaluate whether or not products are safe or fit for human consumption. It makes me ashamed for America that cigarettes are such a major export to other countries, especially to those who are still developing in terms of economics and education. I have yet to research the full amount of damage cigarettes are doing in Europe, Canada, or other more affluent regions, but I regret the fact that cigarettes appear to be an American institution, even as our government continues to wage a "war on drugs" against places like Columbia.
Though the government has recently forced the tobacco industry to pay for public awareness advertisements, they have failed to hold the industry accountable for a significant amount of taxpayer expenses on the part of the government. According to another World Health Organization study, a pack of cigarettes in the United States costs the American public seven dollars. Half of this is in disability expenditures and lost work productivity due to illness; the other half is because of people dying too early. New York is the only state that comes close to matching this loss from the collective public; the price of cigarettes after taxes is seven dollars. However, some of that money is not tax, but instead goes back to the industry that manufactures the cigarettes; no state reclaims the total cost to the public. In the majority of places, a pack of cigarettes costs between three and four dollars, with states reclaiming less than half of their destructive value.
However, the economic damage is still done to the buyer. Cigarettes are marketted towards the very people who can least afford them. The working poor, who frequently have no health insurance but are ineligible for government "Medicaid" because they are working, are among the heaviest of smokers. The cost of smoking a pack per day adds up, ignoring medical expenses and lost work time, to more than $100 a month, a sizable expense for someone living paycheck-to-paycheck.
A large number of people on welfare are also smokers, however, and the public is paying for both their cigarettes and their medical expenses. One third of total government spending in the United States is on public health care, and a substantial portion of that is being spent to treat people for the damage done by smoking. The money involved is on the order of billions of dollars annually--comparable to the total assets of the richest people in the world.
Peer pressure is at an all time high. Cigarettes are most popular among adulescents and young adults. By their mid-twenties, most regret ever starting the habit. But, when I ask them why they started, invariably they report that it was simply what others were doing.
Dipping tobacco is not any less hazardous; you are simply changing the route in which the contaminant enters the body. Cigarette smoke does not stop at the lungs; it infiltrates the entire body. Changing the route of administration does not change the drug.
That said, cigarettes have been substantially more heavily researched by the industry itself. The cigarettes of today are much more noxious and toxic than those of days past. People often tell me that they don't always remember cigarettes being so foul-smelling. The reason behind this observation is that modern cigarettes contain additional contaminant compounds specifically designed to make the combined drug more addicting, sacrificing less important factors such as a pleasant aroma in the process.
Meanwhile, government funded studies have established that cigarettes are more damaging than all illegal drugs in the United States combined. By comparison, consider marijuana. Merely possessing this drug will land one in jail in my country, and the government has actively waged a campaign to eradicate the plant from which it is grown--in effect, a biological genocide. This drug is intoxicating in a manner similar to alcohol, which is both legal and readily available. It undermines intellectual capability on a short-term basis, but so do diazepam (Valium) and alprazolam (Xanax), both prescription medicines. It is mild enough that there is an active movement to legalize it, particularly in California, where it has been proposed as a cancer palliation (comfort-measure) drug. By comparison, tobacco is directly responsible for a significant portion of heart disease, stroke, and nearly all forms of cancer, the three leading causes of death in this country. Yet, it is perfectly legal, having been grandfathered in by history and supported by what basically amounts to bribing the lawmakers.
If you smoke, the people who have successfully quit smoking tell me invariably that it was the intention of quitting that made it possible. Desire alone is not enough. One must decide not to do it any more. The ones who had the intention often were able to quit abruptly--"cold turkey." I applaud those who did. However, though I have never smoked myself, I do appreciate that quitting is not always that easy--it varies from person to person. But, to quit, one must have the intention, and with it a viable plan. A lot of people are able to "cut back" fairly easily. It is not the same as being a non-smoker; even a single cigarette daily continues to burn away the protective lining of the bronchi in the lungs. But, it is an improvement. However, many people get caught up in the process of cutting back and never make the final move to quit altogether. It is important to set goals and have a plan, as well as to realize that in order to quit smoking, one must realize that at one point, one must not pick up a cigarette, not light it, and not put it in one's mouth.
If you do not smoke but did in the past, you must not take up the habit again. Very often, people will restart after facing hardships. Very often, I am told by a patient that they quit smoking for awhile but started again after a family member died. It is important to remember that the relaxation from smoking is an illusion, and that nicotine worsens anxiety. It is one of the worst things one can do for anxiety short of an addiction to tranquilizers like Xanax.
If you are a nonsmoker, stay that way, and be committed to educating the public and voicing out against the abuses of the tobacco industry. If you live in the United States, vote in favor of the continuing push to reduce public smoking, and vote against officials who receive large grants from tobacco companies. If you live outside the U.S., pressure your government not to accept cigarette imports, or in turn to put pressure on the American government to regulate its exports more responsibly.