On the face of it, what could seem more ridiculous than rolling up a dry leaf, setting fire to it and breathing in the smoke? Walter Raleigh helped Europe by bringing home the potato, but bringing tobacco to the Old World was not one of his greatest achievements.
The comedian Bob Newhart’s act, pretending to be Raleigh explaining smoking, who was questioned, “Stick it in your ear, do you Walt?” summed up the ridiculous nature of smoking. It is also a major cause of disease, from life taking cancer, to life shortening heart, lung and peripheral vascular complications, and the estimate of deaths per year due to tobacco are in the order of 5 million world wide, and half a million in the US.
But it’s a major industry, a major source of revenue for governments that ban one drug and tax another (King James 1st had a 4000% tax), though analysis suggests governments that support health care lose more than they gain if the cost of medical treatment is balanced against tax revenue – and that does not take into account the social issues of disabled persons who burden their immediate families and society in general.
But maybe that isn’t fair to Sir Walter Raleigh, for the noxious substance nicotine is named after Jean Nicot who introduced the tobacco plant to France, believing it to have therapeutic qualities; Linnaeus, the great botanical classifier named the plant Nicotiana tabacum after Nicot, and a chemist named the substance extracted nicotine. This was almost certainly only one of the routes by which tobacco came to England, it was already native to Virginia where the Virginia Company developed plantations. All an excellent example of “the road to hell is paved with good intentions.” To be fair to Monsieur Nicot, his nicotine is only one of the many problems associated with tobacco.
Is there anything to say in favor of tobacco?
Obviously people like it, or they wouldn’t go on smoking it, despite the cost and health hazards. It gives to some a degree of pleasurable sensation and a sense of mental alertness. There is also a social aspect, being “one of the guys” male or female, and not standing out from the crowd – an attraction particularly strong for the young and the socially ill at ease.
It’s a dirty habit, ash sprinkled down the front of the smoker’s clothing, butts in overflowing ashtrays or stubbed out in the bottom of a coffee cup; butts thrown on the sidewalk outside the buildings in which smoking is forbidden. Clothes reeking of tobacco smoke, offensive to non-smokers who have to share the same vehicle.
Despite what the manufacturers try to contend, smoking is an addiction if the onset of physiologic changes caused by its withdrawal is the measure. Acquiring an addiction can never be an advantage; its problems are particularly manifest when the smoker runs out of cigarettes or is trying to quit – everyone around him will suffer from his “nerves” and poorly controlled temper. Perhaps that’s why smokers, in comparison with non-smokers, are twice as likely to get divorced.
It isn’t the nicotine that causes the cancer, it’s the 19 agents called carcinogens like the polynuclear aromatic hydrocarbons such as benzopyrene, nitrosamines and acrolein. These substances in the smoke bind with DNA, alter its structure and if you’re lucky kill the cell; if you’re less lucky the cell is altered and in its multiplications may form a cancer.
Particularly well known is cancer of the lung, but these carcinogens will pervert cells elsewhere in the body provoking cancer in adrenals, cervix of uterus, colon, gallbladder, kidney, liver, rectum, and small intestine.
Nothing causes the Emergency Physician more aggravation than seeing a patient gasping for breath due to chronic obstructive lung disease (COPD), but holding a lighted cigarette in his hand and extremely reluctant to let it go so oxygen can be used without causing a fire. The carcinogens described also set up an inflammatory process that ultimately results in scar formation and severe restriction of the lung’s ability to exchange carbon dioxide for oxygen, hence the patient’s dusky grey-blue color.
Before the COPD gets so severe, there are years of ignored warnings to quit when the patient has that “smoker’s cough,” the need to spit excess sputum, and chronic shortness of breath (SOB) with the least exertion such as climbing stairs.
Carbon monoxide poisoning
In house fires, more people die of carbon monoxide (CO) poisoning than are burnt to death; before “natural gas” replaced coal gas, suicide was commonly effected by “turning on the gas tap.” Carbon monoxide is found in all smoke, cigarettes are no exception. Whereas carbon dioxide (CO2)is rapidly cleared from the red cells that transport it to the lungs, carbon monoxide tends to persist, and can very significantly reduce the amount of oxygen the blood can carry. The habitual smoker reduces the oxygen carrying capacity of his blood.
A direct effect on heart output by increase in heart rate can be attributed to carbon monoxide, but the major issue for the heart is the effect of cigarette smoke chemicals on blood vessels in general and the coronary arteries in particular. The cholesterol balance is adversely altered, more low density, less high density lipoprotein, blood is thickened by changes in fibrin and platelets, and degenerative changes in the arterial wall (arteriosclerosis) are to be expected, with concomitant arterial blockage and “heart attack.”
The changes described in the coronary vessels occur throughout the vascular system, making obstruction of other vessels more likely, worsening changes that occur associated with type two diabetes in the kidney and eyes, raising blood pressure by increasing peripheral vascular resistance.
There is a specific inflammatory form of peripheral vascular disease, Buerger’s disease associated with smoking, the blood vessels are obstructed and amputation of the limbs results – less common now but one used to see in Veterans’ hospitals men in wheelchairs, both legs amputated at the thighs, holding a cigarette jammed between remaining stumps of fingers.
The advent of medication for erectile dysfunction with the repeated smug imaging on television of the man who takes the right pill, fails to report erectile dysfunction is 85% more likely to occur in cigarette smokers due to the changes in the arteries described.
Not everyone wishes to live for ever, but if you don’t smoke, you will on average live 14 years longer than your neighbor who does. Put another way, the non-smoker is three times more likely to live past the age of 65 than is the smoker.
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