Cigarette Smoking – The #1 Preventable Cause of Death in the USA
You’ve all heard it.
You’ve all seen it.
You all know it.
Every cognizant person in the United States knows that smoking is bad for you.
How bad? I’m glad I asked!
I’m going to just list some statistics here, in an effort to overwhelm your brain with the concept that smoking is so bad for you (and those around you), that it will seem ludicrous why anyone in their sane mind would choose to smoke, over not smoking. I will footnote the statistics at the bottom of the blog.
- Smoking is the #1 preventable cause of death in the US. 438,000 deaths annually are smoking related. To put it another way, 1 in 5 of all deaths are due to cigarettes. That’s 1200 deaths daily, 50 per hour, almost 1 every minute of every day…no vacations.
- There are over 4000 chemicals in cigarette smoke. 40 of them are known carcinogens. Many more of them are suspected carcinogens.
- 30% of all cancer is due to smoking. 90% of all lung cancer in men and 80% in women.
- Men who smoke are 23 times more likely to get cancer. Women who smoke are 13 times more likely.
- Smoking is directly related to lung, pancreatic, laryngeal, mouth, bladder, esophagus, kidney and cervical cancer.
- Second hand smoke causes 5000 lung cancer deaths each year to non-smokers, plus an unknown number of deaths from other cancers. These other data are just trickling in, and it looks bad! This is why it is illegal to smoke in public buildings in many states.
- Smoking causes hypertension and lowers HDL cholesterol (the “good” cholesterol)
- Smoking is the #1 cause of Atherosclerosis (i.e. hardening of the arteries), the #1 risk factor for heart attacks and strokes.
- Nicotine is one of the most potent constrictor of blood vessels in the world. Constriction of blood vessels leads to restricted blood flow and high blood pressure. Restricted blood flow leads to difficulty fighting infections, aging skin and even blood clots anywhere in the body.
- Smoking makes it 4 times more likely you will die of a heart attack or stroke. 100,000 deaths annually are blamed on heart attacks directly attributed to smoking.
- Damage to the respiratory system from cigarette smoke is a major contributing factor in pneumonia, bronchitis, emphysema and influenza. In the United States 14,200,000 people have been diagnosed with some form of Chronic Obstructive Pulmonary Disease (COPD). Fifteen percent of all smokers will develop COPD and ninety percent of all COPD deaths are related to cigarette smoke.
- 6.5% of pregnant women still smoke. This puts their babies at risk for miscarriage, low birth weight, stillbirth and SIDS (Sudden.Infant.Death.Syndrome.)
- Smoking is responsible for more deaths each year than drug and alcohol abuse, car crashes, AIDS, murder and suicide put together. Think about that the next time you light up.
Get it? Got it? Good. Hopefully we are now on the same page. Smoking is bad, uhmmmkay? Lifetime smokers (i.e. 20 or more years of smoking 1 pack-per-day) live up to 8 years less than their non-smoking counterparts. Smoking for those 20 years also cost them about $50,000, just in the cost for the cigarettes alone.
To give you some idea how bad it is (in case it still hasn’t sunk in): If a patient comes into my office with high blood pressure, high cholesterol and obesity and I get all of these problems under perfect control, the benefit of those changes fail to meet the life-extending benefit of getting that same person to quit smoking and leaving all the other problems untreated. Only Diabetes compares, when it comes to shortening lifespan, amongst cancer/heart disease risk factors, and it is still in 2nd place.
So what can we do about it? Quit, of course!!
Ahhh…so easy to say (errr….type!), and so hard to do. Why is it so hard to quit smoking? It’s just will power right?? If you really want to quit, you can, right? It is not as easy as that. Nicotine (the addictive substance in cigarettes) binds itself to receptors in your brain. It binds itself so hard to those receptors that scientists and doctors call them “Nicotinic Receptors” even though nicotine is not what was intended to bind to them (brain neurotransmitters are supposed to bind to them!). When those receptors are flooded with nicotine, they nudge the happy portions of the brain.
“Yum!” says the brain!
Unfortunately, the brain is also smart. It realizes that those receptors are being overstimulated and slowly decreases the number available so the brain can’t be so overstimulated the next time! Over time, with fewer and fewer receptors available, your brain needs every single one of those receptors stimulated in order to just feel “normal”!! So when you take away the nicotine, the body has only a few receptors left and not nearly enough normal neurotransmitters to stimulate them all! This is the hard part for smokers. Really hard. They really need those receptors to be stimulated…there are just a few left and they’re hungry! Their brain needs a nudge in the yummy place, just a little nudge, so it can feel “normal”. It doesn’t even want to feel “Yum!” anymore, it just wants to feel normal. When a smoker quits smoking, it can take weeks or even months for those receptors to grow back. Smoking is one of the two toughest addictions to deal with (heroin being the other).
So what can you do to make it easier to quit? Fortunately, medical technology has come a long ways to help you on your quest to be healthier. More statistics coming here (I apologize, but they do serve a purpose).
4% – your chance to quit smoking for 6 months if you do nothing at all to help yourself apart from stopping cold turkey without any aid. Pretty lousy odds. No wonder it takes 6 attempts to quit, on average, before most people manage to do it. “Cutting back” slowly on smoking, with a goal of quitting, does not work. I have been practicing medicine for 15 years and I’ve never seen it work even once for any length of time. You will never ever give your body the chance to start making new nicotinic receptors as long as you are feeding it nicotine; even a little.
8% – your chance to quit with Nicotine Gum or a Nicotine Inhalation device. Sounds lousy too, but the advertising will say “Doubles your chance to quit!!” and they are right. Certainly not the best way to quit, but it is easy (and profitable for the drug companies). The problem with Nicotine-Replacement strategies is that you are not actually eliminating the addiction. You are substituting a less harmful means of getting Nicotine into your body, but eventually you will have to get off the Nicotine, or else you are just addicted to the Gum or the Inhalers!
17% – your chance to quit with a Nicotine Patch. Now we’re talking. Four times better than using nothing. You still have the same problem with not dealing with the Nicotine addiction, but at least you don’t have all the carcinogens. Some studies have quit rates as high as 25%. My personal experience is closer to the 17% than the 25%.
28% – your chance to quit with Zyban. This is a drug (also called Wellbutrin or generic buproprion, when used to treat depression) that must be prescribed by your physician. It’s use is limited by some side effects, including insomnia and seizures (especially in people who drink alcohol regularly). Still, for those who don’t drink and have no history of seizures, it is a gargantuan leap in effectiveness…and no nicotine!
50% – your chance to quit with Chantix. This is a new drug which must be prescribed by your physician. While the published effectiveness is 50% over 6 months, my experience with the medication in my practice is much better than this. The drug binds to those same nicotine receptors in your brain, blocking the effects of nicotine altogether. This drug works great, but is also limited somewhat by side effects. Almost everyone who takes the medication described vivid dreams (not bad…just vivid…some people might call that a benefit!). It can also cause headaches and nausea, which usually force us to lower the dose. Worst of all, it can make depression worse in people who have a history of depression. For this reason, physicians rarely will prescribe it to someone who has depression. New depression, caused by the medication, is much rarer but is also reported. All of these side effects go away if you stop the medication.
All methods work better if you use “support mechanisms” to help you “stay quit”. This includes psychotherapy, support groups or even just quitting at the same time as a friend or loved one. People who are involved in 12-step groups for alcohol/drug addiction find that the 12-step program works very well, especially in conjunction with one of the aids listed above. The statistics on 12-step programs (like Alcoholics Anonymous) are scant, since the programs do not allow themselves to be studied, in order to remain anonymous. However, some small studies done clandestinely seem to show a 30% quit rate for alcoholics to quit alcohol addiction. How well it might work for nicotine is unknown, but nicotine is regarded as a harder addiction for most, but not all, people.
There are some statistics for Acupuncture, Laser Treatments and Hypnosis. Acupuncture and Hypnosis statistics, when applied to a broad population, fail to show enough benefit over placebo to be considered as mainline therapy. However, there are people who are strong placebo-responders, and these methods might be very beneficial to these individuals. Laser treatment is a new science, and initial studies look promising, but we are still waiting for enough data to make a decision about it.
Other tricks: Many people associate certain activities with smoking. For example, they are used to smoking immediately after they wake up, the moment they get in the car, after meals and anytime they are in a social situation where smoking is common (like a bar, or on the golf course). Initially, avoiding these situations might make it easier to quit, until the withdrawal time is over (more on this in a moment). When this cannot occur (we gotta drive, right?), try substituting some other hand-oral activity, which will partially trick your brain. I always suggest sucking on lollypops to satisfy the hand-oral craving.
So, about withdrawal. Withdrawal is the time frame when your body is still craving nicotine from a physical/biological standpoint. The worst of it is the first 2-5 days (really!). The remaining withdrawal lasts about 4 months (so doctors usually suggest using the ancillary aids for 4 months: meds/patches/inhalers). This is the time frame when your body is busy making new receptors to replace the ones it lost when you were smoking.
So, if withdrawal only lasts 2-5 days for the awful part and only about 4 months for the easier part, why do people go back to smoking after that so often?
Psychological Addiction. This is probably at least as potent as the physical addiction. Nicotine calms the nerves for some people, so it is self-treatment for stress or anxiety. Smoking replaces food for some people and acts as a mild appetite suppressant, so some people gain weight when they quit. Nicotine is also a stimulant and allows some people to stay alert and awake. For some, it may even be a self-treatment for Attention-Deficit Disorder. Many people who have smoked for a very long time may be unable to perform certain tasks they associate with smoking, so ingrained is the connection between the activity and smoking. Getting over this portion of the addiction (which may be a lifelong struggle) is the portion which might be chalked up to “Willpower” alone.
The very first step is deciding to quit. Your second step should be a visit with your doctor, who can help you decide which method might be best for you, and prescribe any medications which might be appropriate. He will probably also want to follow-up with you regularly, as it has been decidedly proven that when you know you have to see your doctor in a few weeks about the smoking, you are more likely to stay quit!
So quit smoking. Please. For you, your loved ones and those around you!
For global statistics on smoking (even more dire than the US statistics):