Mark Hoofnagle has a MD and PhD in physiology from the University of Virginia, and is now a general surgery resident. His interest in denialism concerns the use of denialist tactics to confuse public understanding of scientific knowledge.
My recent post on tobacco poisoning focused on chronic obstructive pulmonary disease, the cause of about one-third of smoking related deaths. Let's move on to cardiovascular disease (CVD), which accounts for another third.
When we talk about CVD, what are we taking about? The pathophysiology is very interesting...go and read.
Heart disease, which includes heart attacks and heart failure, kills about 100K smokers yearly. This includes people who have a heart attack and die suddenly, but also people who develop heart failure and linger on swollen and breathless.
Strokes kill about 16.5K smokers yearly, which doesn't include smokers who are only disabled by strokes.
Aortic aneurysms kill about 8.5K yearly. That's a fun one. An aortic aneurysm is a dilation of the main blood vessel that leaves the heart. When this tears or bursts it causes horrific pain in the chest or abdomen that radiates to the back. Thankfully the pain often doesn't last long, because if the aorta actually bursts, you bleed out into your chest or abdomen very quickly.
Oh! Wait! I forgot peripheral vascular disease! Who doesn't like gangrene? (Don't click unless you're ready for the gangrene picture.)
Peripheral vascular disease often starts as pain in the calves when walking, but can rapidly progress to loss of a limb. Eww.
I always tell my residents that helping a patient to quit smoking is usually the best thing you can ever do for their health. Smoking is the cause of most preventable deaths in the U.S. and causes about 20% of all deaths. It is impossible to overstate the public health menace that smoking presents. Cessation programs have become more sophisticated, as have the drugs that are available. Patients often ask me if nicotine patches are safe. My usual response is, "Well, are cigarettes safe?" There are very few bad ways to quit smoking. The first step is deciding you're ready. Then, get educated. Resources abound.
Ach! I forgot to tell you....
Average monthly cost of cigarettes: 350 USD. That's a whole lot of money.
Medicine & Health
Comments
If anyone wants to read posts from some really hardcore tobacco addicts just check out this link.
http://www.topix.com/forum/health/smoking
It's really quite sad
Posted by: Pete | July 31, 2008 11:04 PM
I think an anti-smoking campaign which starts "You had better hope the cancer gets you..." would be a damn good thing.
Focusing on cancer when it was a hot topic was a good idea but after reading this and comparing my own knowledge, there were a lot of things i hadn't known because the campaigns mostly focused on that.
Posted by: Richard Eis | August 1, 2008 4:28 AM
Meh, focusing on how smoking might kill you won't be effective to someone who doesn't think their life is that great. The vast majority of people start smoking in their teens (over 90%, I think) and, honestly, teenagers just aren't thinking that much about how they might die.
I started smoking when I was 15. Alpha-1 Antitrypsin deficiency runs in my family, giving me a genetic predisposition to emphysema. My great-grandmother died at age 41 from the disease. I knew all of these things when I started smoking, but I was 15. I couldn't even conceive of moving out of my house and going to college, much less death.
All of my friends who smoked basically thought one or more of the following - we would quit before we did too much damage, we didn't really care if we died at 70 instead of 80, and/or medical science would have better treatments for smoking related diseases by the time we were affected.
Posted by: Natalie | August 1, 2008 10:15 AM
I agree with Natalie - that's why most anti-smoking campaigns don't work. People won't trade a short-term perceived benefit for a long-term risk that might not happen. To get people to give up smoking you have to focus on the immediate and tangible benefits of not smoking (cost, convenience, flying or being in any other no-smoking space is easier to deal with, white teeth, healthier gums, better skin, less coughing, less paranoia about your health).
I'm sorry but speaking as an ex-smoker the pictures of diseased lungs, gangrene, etc are something that happens to someone else, someone who is much older, much unluckier and probably someone who smokes more. You really don't think it's going to happen to you and even then, what's the point given air pollution, passive smoking, etc etc are probably going to cripple your lungs anyway and besides by the time you're that old you'll have given up anyway - it's not like you're an addict. (I am talking about the smoker's mind-set - this isn't necessarily something I agree with)
Funnily enough the things I really hated as a smoker were a) the plastic film on packets that stuck everywhere. I am so happy to be free of that! b) losing lighters and c) people in pubs coming up to you and begging for a cigarette - they were annoying. Buy your own!
I gave up smoking through Alan Carr programme - no patches or products, no cold turkey, no lectures. I don't know if you have it in the US though.
Posted by: Miss Grace | August 1, 2008 11:37 AM
To be successful at anything in life including quitting smoking, the person has to develop the desire or motivation. A smoker doesn't have to stop wanting the cigarette but they have to want something else more than they want the cigarette. When giving advice, most people will give their reasons why they would quit instead of listening to the smoker and trying to figure out what reasons would motivate them--different reasons for different smokers. They say--you can lead a horse to water but you can't make them drink-but you can make the horse aware that he is thristy and remove any obstacles that prevent him from drinking. For free quitting tips, visit: WWW.StopSmokingSTayQuit.blogspot.com VJ Sleight, Queen of Quitting, a former smoker, Cancer Thrivor and Tobacco Treatment Specialist
Posted by: vj sleight | August 1, 2008 2:07 PM
This post makes me want a cigarette.
Posted by: Aaron Kinney | August 6, 2008 6:56 PM
Oh no, it gets worse. Japanese males smoke more than the males of pretty much every other developed country... yet they have the third HIGHEST lifespan rating in the world.
http://www.topix.com/forum/health/smoking/TJV2M9FTI873H6AFE
What am I saying? Dont think Im saying that the ill effects of smoking are untrue, that would be absurd. Clearly smoking is bad for you and those around you. What Im trying to say is that it is possible to live a long, long time (maybe too long?) while still doing things that are "bad for you."
Posted by: Aaron Kinney | August 6, 2008 7:00 PM
Aaron, while it is certainly legitimate to debate the relative utility of tobacco laws, your final statement is essentially meaningless. Assessing risks is about, well, assessing risks. If you study a population (or sample) you assess the relative risks of various exposures. You can make statements about the effect of, say, tobacco on a population, but on a single individual it is always more difficult. I can say that you are "x" times more likely to have heart disease if you smoke, but I can't say whether or not you will actually get heart disease.
Knowing the risk allows you/society to make informed choices. We know that if we expose ourselves to smoke, we are much more likely to suffer and die of certain diseases. Yes, you might get lucky, but if you smoke, you're betting against the House.
Posted by: PalMD
| August 6, 2008 9:46 PM
Is getting someone to switch from cigs to chaw worthwhile from a health risk point of view, or are all tobacco products equally detrimental?
Posted by: Lab Lemming | August 7, 2008 1:43 AM
It's horrid. Instead of lung cancer, head and neck cancers are more common. The surgery for these cancers is...extensive. And there is still considerable cardiovascular risk.
But you won't get emphysema.
All methods of taking tobacco are quite harmful. Nicotine replacement via gum, etc is much safer than dipping.
Posted by: PalMD
| August 7, 2008 8:54 AM
I quit smoking after about 10 years of smoking. I have been smoke free for some 30 years, but have the VERY occasional cigarette. (Like maybe 2 a year.) I don't think I was ever addicted to them as I only smoked about 1/2 a pack a day and most of the time I just held the damn things. It use to be a way to get extra breaks at work. Now, cigarettes are TOO expensive for that kind of luxury.
After reading some of this, I am glad I no longer puff.
Posted by: Qwerty | August 7, 2008 5:02 PM
As a smoking cessation specialist I appreciate your great posts on chronic obstructive pulmonary disease and on cardiovascular disease, PalMD.
Posted by: Stop Smoking | November 23, 2008 3:17 AM