Thursday, January 23, 2014

Combustible Tobacco Kills

Tobacco is a filthy weed,
That for the devil does proceed;
It drains your purse, it burns your clothes,
And makes a chimney of your nose.

Oliver Wendell Holmes (1809-1884)

Smoking is a shocking thing – blowing smoke out of our mouth into other peoples’ mouths, eyes, and noses, and having the same thing  done to us.

Samuel Johnson (1709-1784)

Cigarette smoking is causally related to lung cancer in men; the magnitude of the effect of cigarette smoking far outweighs other factors. The data for women, though less extensive, point in the same direction.
The risk of developing lung cancer increases with the duration of smoking and the number of cigarettes smoked per day, and is diminished by discontinuing smoking.

Surgeon General, Smoking and Health,’Report of the Advisory Committee to the Surgeon General of the Public Health Service, U.S. Department of Health, Education and Welfare,  January 1964

In the face of a long history of reports on negative effects of tobacco on health,  50 million Americans continue to smoke, although the prevalence dropped from 43% in 1965 to 18% in 2012.

In a January 23, 2014  New England Journal of Medicine report, “Smoke, the Chief Killer- Strategies for Targeting Combustible Tobacco Use",  its authors use the word “combustible”  32 times in their 1337 word article.  The health villain in tobacco products, the authors repeatedly assert, is combustible  tobacco  set on fire and inhaled.

The article will leave an indelible impression upon its readers, as it did on me.

 It makes effective, repetitive use of a single word “combustible’ to make its point.  The point is: lighting and burning  nicotine in a cigarette, pipe, or cigar  and inhaling the resulting smoke kills,  much more than e-cigarettes or smokeless tobacco products. 

 Combustible nicotine in tobacco products is the number one identified killer of Americans, and in  it effects especially on the poor, mentally ill, illicit-drug and alcohol users, Native Americans, and lesbian, gay, bisexual, and transgender Americans.  

 Tobacco containing nicotine set on fire in a cigarette, pipe, or cigar accounts for 98% of tobacco related deaths.

The take-home  lesson is:

Burn, burn, burn that tobacco
Inhale that smoke, smoke, smoke,
Puff, puff, puff that cigarette
And you’ll be dead, dead, dead.
Sooner, sooner, sooner than most.

In the words of a 1973  Bob Dylan song, bad health in form of cancer in many organs, chronic  bronchitis, emphysema,  arteriosclerotic disease,  and circulatory diseases will come knock, knock, knovk., knocking at your health care  door.   

Or in the words of Edgar Allen Poe, before the Raven of death comes rapping, tapping at your chamber door,  it is best to say, “Nevermore” to tobacco use.

But stopping smoking is easy to day,  hard to do.  Current smoking cessation strategies fail in the majority of smokers; 70% of smokers say they are unwilling to quit, yet 90% say if they had it to do over again, they would not have started.

What can doctors do to help smokers stop?

1)       Inform patients any tobacco product is harmful, but cigarettes are the most harmful.
2)      Encourage patients to stop.
3)      Give advice on how to quit, counsel them, recommend NRT (Nicotine Replacement Therapies) approved by the FDA
4)      Tell them of the harmful effects of second-hand smoke to their family and others.
5)       Advise l them to stop smoking at home or in their car.
6)       If they use e-cigarettes, encourage them to quit regular cigarettes altogether
7)       Refer them to a quit line or a tobacco cessation counselor
8)      Become aware of and  champion public health measures – increased excise taxes,  clean air policies in your office and hospitals,  graphic images on cigarette packs including 1-800-QUIT-NOW number, advertising and market restrictions,  no sales under 21,  limited number of outlets selling cigarettes, prohibition of visual advertising.

Tweet:   Inhaling combustible tobacco products is the number identifiable killer of Americans and is associated with development of multiple diseases.

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