Bad news for smokers—it’s worse than you thought

The study of more than 200,000 people, published this week in BMC medicine, found about 67 percent of smokers perished from smoking-related illness. That rate is higher than doctors previously estimated.

http://www.washingtonpost.com/blogs/wonkblog/wp/2015/02/26/the-terrifying-rate-at-which-smokers-die-from-smoking/

Besides lung cancer, smoking also increases the risk of at least 13 other cancers including cancers of the larynx (voice box), oesophagus (gullet), mouth and pharynx (throat), bladder, pancreas,  kidney,  liver,  stomach,  bowel,  cervix, ovary, nose and sinus, and some types of leukaemia. There is also some evidence that smoking could increase the risk of breast cancer.

Quitting smoking unassisted

It’s nice when medical opinion catches up with mine.  For years I have questioned the use of public funding for smoking cessation—for Medicaid and Medicare patients, for prisoners and various minority populations and those  in the bottom quintile. It seemed a sop to the pharmaceutical companies, social workers and various cessation gurus.  With no great research on my part I noticed that although I know many former smokers—perhaps a hundred or so—not one of them quit using a drug or group support or counseling method.  The two closest were my father, who quit at 39 when he began spitting up blood from his coughing and lived to 89, and my father-in-law who quit when he reached for his third pack of the day and lived to be 93. Both quit cold turkey. Two of my father’s brothers, Russell and John, and one of his sisters, Gladys, did not quit, developed cancer and died painful deaths.  My father-in-law’s wife, Rosie, died many years before her husband; she didn’t stop smoking and developed lung cancer. I couldn’t begin to count the people my age that I know who are former smokers, including brothers-in-law and sisters-in-law. I know one man who used God—he says he challenged God, if he were real, to take away his desire to smoke. Poof, it was gone, and he stopped. He became a believer—in God. I know a few who became desperately ill, heart disease, COPD, stroke or cancer, and then stopped—and you can call it fear, but it was sheer will power. Their lives, although extended, were shorted by the years of foolishness and addiction.

A 2013 Gallup Poll of former smokers showed only 8% attributed their success to nicotine replacement therapy—gum, NRT patches—or prescription drugs.  56% credited “cold turkey,” “will power,” or “mind over matter.”  In other words, they decided to kick the filthy, health killing habit.  As a non-smoker, I am thrilled I can go into a restaurant or public event, and not leave smelling like a gambling casino of the 1950s.  However, there was a dramatic drop in smoking among Americans after the 1950  report linking tobacco and cancer, from 7.7 million former smokers in 1955 to  19.2 million in 1964, to 36.2 million in 1979. This was before the anti-smoking campaigns, the laws, and the drugs. Researchers could clearly see and puzzle over the success rate of these people, but chose to go the “assisted” route to find the perfect drug or program.

In my opinion, except for those unfortunate enough to have been mainlined nicotine in the womb, the vast majority of smokers pick up the habit through choice and social influence.  And that’s the way to quit.  Just do it, and don’t hang around with smokers.

http://jama.jamanetwork.com/article.aspx?articleID=1812969

Patch, pill or hypnosis, how did you quit?

I'm still waiting to meet a former smoker who quit permanently as the result of a government paid for program in their health plan, a work sponsored program, a drug patch or pill, hypnosis, talk therapy, etc. And I don't mean the 3-6 month quitter that the research reports in a clinical study so they get another grant from the NIH.  I'm sure they are out there, or why would we be spending so much money on them? [sarcasm].

Just Google "Smoking Cessation programs" (about 4.5 million hits).  Mayo Clinic claims it's had 45,000 participants in its program to stop using tobacco (smoking and chewing), with 110 randomized clinical trials involving more than 25,000 research subjects.  Where are the success stories?

When I see reports on what percentage of income the poor spend on cigarettes, there is usually a follow up appeal on why we should be spending more money on helping them quit.  Put where is the research that pills, patches, hypnosis and counseling actually pay?

http://www.nytimes.com/2012/09/20/nyregion/poor-smokers-in-new-york-state-spend-25-of-income-on-cigarettes-study-says.html?_r=0

One of these things is not like the others

Didn't Sesame Street have a song like that?

One of these things is not like the others,
One of these things just doesn't belong,
Can you tell which thing is not like the others
By the time I finish my song?

The CDC calls the following 5 items, "high-value prevention services" which can save 100,000 lives each year.

1. Smoking cessation assistance
   
2. colorectal cancer screening
   
3. breast cancer screening
   
4. annual influenza immunization
   
5. daily aspirin to prevent heart disease.

Three quarters of former smokers quit on their own. And I don't know anyone who successfully, permanently stopped smoking with a government sponsored workshop, phone call counseling, nasal spray or a drug patch. Do you? The studies only have a few months or a year follow-up, but somehow the drug companies have got that one included in many government programs.

But I have heard of other uses for the nicotine patch I might consider--like improving memory in older persons. Now that I could get into.

Only the aspirin and the immunization are actually preventative. Two of these are screening for what you already have or will have. Breast cancer screening can find a lump--but doesn't prevent it. Colonoscopies can spot trouble spots that will become cancer but aren't there yet.

Twelve other reasons to stop smoking

Besides the obvious one, death. The list is in the November 14, 2008 US News and World Report. I came across it today looking for the success rate of cessation programs, either medication and/or counseling. I wanted to know this because of the billions the government spends on that through Medicare and Medicaid, and the only former smokers I know who kicked the habit for good, did it without either. Like my Dad, who quit at about 39 when he started coughing up blood (died at 88), and my father-in-law (died at 92) who quit cold turkey around 50 when he reached for that 3rd pack of the day the first time.

So here are 12 other reasons. Link.

1. It fogs the mind. . . smoking in middle age is linked to memory problems and to a slide in reasoning abilities . . elderly smokers face a heightened risk of dementia and cognitive decline, compared with lifelong nonsmokers.

2. It may bring on diabetes. . . current smokers have a 44 percent greater chance of developing type 2 diabetes than nonsmokers do, and the risk was strongest for those with the heaviest habit, who clocked 20 or more cigarettes per day.

3. It invites infections. . . there are very strong data showing that the risk of infection by pneumonia-causing bacteria is substantially greater for smokers than for nonsmokers. . . research suggests that smoking may interfere with immunity, compromising people's ability to fight infections. . . children exposed to secondhand smoke at home during early infancy (especially those born prematurely or with a low birth weight) are more prone to a throng of severe illnesses.

4. It may stultify a sex life. . . Smokers are more apt to experience erectile dysfunction than nonsmokers are, and this risk climbs as the number of cigarettes smoked increases.

5. It may lead to wrinkles...everywhere. . . including the inner arm and perhaps the buttocks.

6. It may hasten menopause. . . chemicals in cigarette smoke can hurry menopause by killing off egg cells made by ovaries, thereby dwindling the egg cell reserve.

7. It may dull vision. Several studies have found a robust link between smoking and eye disease . . . active smokers may face two to three times the risk for developing the disease experienced by those who have never smoked.

8. It hurts bones. Smoking weakens the body's scaffolding and is a serious risk factor for osteoporosis . . . Smokers may also experience slower healing of broken bones and wounded tissues than do nonsmokers.

9. It may injure the insides. . . heartburn, peptic ulcers, and possibly gallstones, according to the National Institute of Diabetes and Digestive and Kidney Diseases. . . elevated risk of developing Crohn's disease.

10. It may stifle sleep. . . smokers are four times more likely to get nonrestorative sleep than those who don't smoke, and researchers deemed nicotine the likely culprit.

11. It shaves years—and quality— off life. Men who have never smoked live on average 10 years longer than their peers who smoke heavily.

12. Tobacco use and smoking have been linked to much more than lung cancer. . . Lung and bronchial cancer topped the list, naturally, but other types included stomach, pancreatic, kidney, urinary bladder, and cervical cancer.

The smoking violin

Each week in the Lakesider (our weekly newspaper) there's a notice about smoking in "public areas." By next summer you won't be able to step outside a shop, restaurant or auditorium to smoke, because you'll be on public grounds. Depending on how that's interpreted, everything here belongs to the association except your cottage. An oldtimer told me last week (because we've only been coming here since 1974 we aren't oldtimers yet) that when he was a child, the cars and luggage were searched carefully before visitors were given a gate pass to be sure no one was bringing in alcohol. Not sure what they'll do about the smoking violinist I've been seeing for 30 years. Every day during symphony season, he walks the streets when he's not performing or in rehearsal. This man probably walks 4 or 5 hours a day and looks no different than the first time I saw him.

Smoking is rather rare these days among the educated middle and higher income group. It's just not reinforced among your peers, the way it was in high school, or the working place of blue collar workers. Obama's first tax was on the poor, less educated and lower income people. His plan to tax the middle income is buried with the health care premiums combined with the tax code in his single payer plan. The Lakeside violinist is probably not wealthy, but the new tax didn't defer him. I imagine his wife, mother, colleagues, doctor, pastor, friends, everyone has told him to stop. I don't think Lakeside rules or the President (who hasn't stopped smoking himself) with higher taxes, will stop him. It's a mind altering drug, and terribly addictive, particularly if started young when the brain is still developing.

Thursday Thirteen--13 reminders

In the previous entry I reported on supplements C & E not helping much. What to do? Here's my thirteen reminders on healthy living--from years of observation, and several previous blogs.

1. Choose your parents and ancestors wisely.
   
2. Eat all the colors, the darker the better.
   
3. Learn to prepare your own food--it's cheaper and healthier than eating out frequently or buying processed. Lots of wonderful root crops; and frozen will be better than that stuff that sits in the back of the frig for 2 weeks, which may have been old when you bought it. Don't bother with those search and destroy missions; the human race got this far without infomercials and expensive eating programs.
   
4. Avoid high calorie, sugary or salty snacks and desserts. They just make you more hungry; but also, don't deprive yourself completely or you'll binge. Chocolate in moderation is good for you. I hope they don't reverse that research.
   
5. Don't smoke at all; not for any reason, no, no, no, not any weed. Nicotine is never good for you, gives you wrinkles, yellow teeth, bad breath, puts you at risk for all sorts of diseases, and you smell bad. Plus it costs hundreds a year. That third hand smoke danger stuff is an urban legend, however. Based on nothing but personal opinion survey. No studies--zip, nada, zilch. If you get too hyper, you'll just give yourself an ulcer.
   
6. Don't have more than a few alcoholic drinks a week; red wine may even be good for you--even more so with a little chocolate. But grape juice is good, too. I cooked up a bunch of grapes getting a little old along with some fresh pineapple starting to turn and a tired apple. Ran it all through the blender, and my! that was tasty.
   
7. Get regular exercise. I know, I know. I hate it too. But it's good for you. Especially the bones. It will also help your balance. Falls are dangerous. You don't want to go to the hospital or nursing home for any reason--bad germs there. Plus it sets you up for pneumonia.
   
8. Wash your hands often. Keep a little bottle of the alcohol rub around for emergencies.
   
9. Brush your teeth.
   
10. Floss. Protect your gums. You can really get bad stuff from decay around your gums. I hate to floss. And I had gingivitis in my 30s, so I should know better. But I do have all my teeth--even my wisdom teeth. That helps me write 11 blogs.
    
11. Protect your ears. Oh, I hate to see these kids blasting away their hearing hour by hour with ear buds and i-pods. Hearing is so precious. My grandmother was blind, and you know what she said? Hearing loss is worse than sight loss because it interferes with communication. I can't stand it when I see parents taking their helpless infants and toddlers into the loud, clangy bangy church service (called x-alt at our church) with the drums and rock music. It's child abuse in my opinion. If my ears are too tender for that CCM noise, think what theirs must be!
    
12. Choose solid, stable, supportive shoes. Oh you foolish girls, trying to look like you have 5 more inches of leg by wearing stiletto, expensive pumps with pointy toes. I like a little stacked heel just because it's comfortable, but you're asking for sprained ankles and strained backs. You'll have corns, bunions and arch cramps for sure.
    
13. Forgive. Don't carry around grudges. How long ago did she say that nasty thing? 20 years? Bad thoughts pull down your face and cause you to get less sleep, which give you bags under your eyes.

The Old Thursday Thirteen is gone; here's the new site. http://thursday-13.com/

My Dad was a smoker--from the archives

Oh, I remember that cough. We children had never known anything else but Dad's coughing. And the blue haze everywhere in the house if he was home. In those days, I didn't find the smell unpleasant like I do now. It was always a mix of after shave, hair cream, cigarettes and fuel oil. But what must my mother have thought? Neither of her parents smoked. Her mother was a health-nut--wouldn't even eat red meat, and she was always airing out the house.

Dad told me 40 years later [after he'd quit] that he wanted a cigarette for 20 years. When I was younger, I didn't think about that too much. But now I'm in awe of his focus, drive and determination. He was not always a pleasant person to be around when I was growing up. I wonder now if he just wanted a cigarette, if his head hurt, his eyes burned and his skin crawled for nicotine. My parents weren't social--Dad dealt with people all day, 12 hours a day and a houseful of noisy children at night. And all the while, craving a cigarette, knowing that would take the edge off.

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His father's heart

The excerpt from Steve McKee's book, "My father's heart" in today's Wall St. Journal was riveting. I thought I'd forgotten most of that phase of Dad's life. How different it could have been for our family if he hadn't quit when he started to cough up blood.

On Sept. 30, 1969, 16-year-old Steve McKee watched his father die of a heart attack on the couch in their TV room. A lifelong smoker, John McKee had already been stricken by a heart attack six years earlier. But, unable to quit his three-pack-a-day habit, he made no lifestyle changes that might have prolonged his life. Deeply disappointed by his father's seeming surrender to cardiovascular disease, Mr. McKee -- now an editor at The Wall Street Journal -- set out to find the man who died before his son could know him. With this memoir, he sought to find a measure of understanding for his father, and anyone affected by smoking and heart disease. . . .

My father and my father-in-law both stopped smoking cold turkey as they began to move beyond the line of two packs a day. Dad was probably 36 or 37 when he began to cough blood; my husband's father was older, maybe in his 50s when one night out with his friends he started to open that third pack, he put it down and quit. My dad lived to 89; my husband's dad to 91; my husband's step-father, also a very heavy smoker who didn't quit, to 75; my husband's step-mother, also a smoker, died at 71 of lung cancer. All began smoking in their teens and really enjoyed it.

"My sister Kathy and I woke up every morning to the sounds of the same alarm clock: Dad's cough, his cigarette hack. Breath in. Pause. HACK. (Catch) Cough. They came in stanzas--three, four, five at a time, the second-to-last always the biggest crescendo." writes McKee

Oh, I remember that cough. We children had never known anything else but Dad's coughing. And the blue haze everywhere in the house if he was home. In those days, I didn't find the smell unpleasant like I do now. It was always a mix of after shave, hair cream, cigarettes and fuel oil. But what must my mother have thought? Neither of her parents smoked. Her mother was a health-nut--wouldn't even eat red meat, and she was always airing out the house.

Dad told me 40 years later that he wanted a cigarette for 20 years. When I was younger, I didn't think about that too much. But now I'm in awe of his focus, drive and determination. He was not always a pleasant person to be around when I was growing up. I wonder now if he just wanted a cigarette, if his head hurt, his eyes burned and his skin crawled for nicotine. My parents weren't social like McKee's parents. Dad dealt with people all day, 12 hours a day and a houseful of noisy children at night. And all the while, craving a cigarette, knowing that would take the edge off.

I won't be reading the book, but I'll remember it could have been me.

Link to the review is here.