Why Would Anyone Choose to Smoke?
By Dr Syed Amir
Bethesda, MD
The American Surgeon General’s Report issued on January 14, marking the 50 th anniversary of the historic first Report that came out in 1964, attributes a number of diseases, besides lung cancer, to smoking. The first report had suggested an association of smoking with lung cancer. Meanwhile, new and substantial evidence, accumulated over half a century, has identified smoking as a major cause of heart disease, emphysema, stroke, asthma, colorectal cancer, and type 2 diabetes. Although, the conclusions cited in the current Report are drawn from studies on the US population, they most likely have general and wider applicability around the globe.
The latest report estimated that nearly 21 million Americans had died prematurely during the past fifty years from illnesses directly related to smoking. Of these, six-and-half million died of cancers resulting from smoking. Over 87% of all lung cancer deaths and 61% of those from lung ailments were caused by smoking. A troubling finding is that some 2.5 millions nonsmokers also died of heart disease, stroke or cancer through no fault of their own. They were close relatives or friends of smokers who were exposed to second-hand smoke over long periods by being in close proximity to smoking relatives or friends.
The exposure to second-hand smoke is especially injurious to infants and children whose bodies are still developing and who live in the same household as smokers. An estimated 10,000 babies died from sudden infant death syndrome (SIDS), traceable to smoker parents, especially mothers. In order to protect nonsmokers from the toxic effects of second-hand smoke, smoking in the US has now been banned from all public places, restaurants, offices, shops, and public transport, buses, planes and railways. However, there is no easy way to protect children or adult relatives who share the same household.
An intriguing finding is that today’s cigarettes are more deadly that they used to be only a few decades ago. The reasons are not entirely clear. The authors speculate that the tobacco companies have redesigned cigarettes and cigars by incorporating ventilated filters and blended tobacco, lowering their tar and nicotine content. Consequently, the new brands of cigarettes require heavy puffing to draw the full pleasure: in the process, the smokers inhale larger quantities of toxic substances.
There has been a long and sustained effort in the US spread over several decades to educate the public, especially the young, about the deadly effects of smoking. The young are especially vulnerable, as the smoking habit acquired during the teenage years is extremely difficult to abandon in later life. Nicotine, the main ingredient in tobacco, is highly addictive and, once hooked on it, cessation is extremely difficult to achieve, just like from other life-threatening drugs, heroin. Women smokers are at an even higher risk than men for disease. According to a recent research paper in the New England Journal of Medicine, women who smoke are much more likely to die from lung cancer, as compared to men, as they usually acquire the habit at an early age.
Campaigns in affluent Western countries to highlight the harmful effects of smoking have been exceedingly successful and, since 1965, the smoking rate in the US has declined sharply from 42 to 19 percent of the population and is still going down. The prestigious American Journal of Medicine reported that cessation of smoking has saved more than eight million lives over the last fifty years, and raised hopes of a longer lifespan for many more. Giving up smoking at any age adds extra years of life. Quitting smoking at the age of 40, for example, erases almost all the damage done by cigarette smoking in the previous years.
Unfortunately, as their market share in the Western countries has shrunk, the tobacco companies have now concentrated their efforts on the developing countries where people are less well informed and thus more vulnerable. In an article published two years ago in the Journal of the Pakistan Medical Association, investigators at the Agha Khan University Medical College, Karachi, reported that 33% of middle age males in their survey had used tobacco products, including cigarettes, chewable tobacco, and water pipes. Many of them were drawn from the ranks of colleges students. There is a growing popularity of shisha smoking which is mistakenly considered less harmful than cigarette. The authors lamented lack of efforts to educate the public about the harmful effects of smoking.
While there has been a marked decrease in cigarette smoking in the West, the popularity of shisha smoking has been growing in some countries. Figures collected and published in 2012 by the British Heart Foundation, claimed that there had been a 210% increase in shisha bars in the UK, catering to mostly young men, causing much concern among the British health officials.
Over a span of five centuries, tobacco became the narcotic of choice for many people. It was unknown before Christopher Columbus discovered the Americas. According to the legend, American Indians introduced him to the dried tobacco leaves, reportedly in October 1492. The tobacco plant was subsequently brought back to Europe by sailors accompanying Columbus. In Europe, its popularity grew enormously as initially an astonishing number of curative and therapeutic properties were ascribed to it. It was even incorporated in the Spanish pharmacopeia of the sixteenth century, listed among medicinal plants derived from the New World. The advent of cigarettes in the late nineteenth century gave a big boost to smoking, making it a convenient and inexpensive means of delivery.
The practice spread worldwide. In India, smoking Huqqa was common place during the twilight years of the Mogul empire among the court patricians. The last Mogul emperor, Bahadur Shah Zafar and his father, Akbar Shah II, are often seen in pictures smoking Huqqa while holding court. Even the British servants of the East India Company adopted the practice, considering it a benign practice.
The truth about tobacco, as it turned out, was far different than had been understood by the Europeans. Yet, for the British colonizers in America, tobacco cultivation and export became a big profitable business, and smoking became a highly popular habit worldwide. We have no record of how the Native American Indians who had cultivated it for centuries were affected by its use, or whether they had any awareness of its toxic effects. They used tobacco extensively on all ceremonial occasions, as well as for medicinal purposes. However, since their normal life span was relatively short, the deleterious effects of tobacco probably did not fully manifest in most cases.
The New World gifted us a number of new, highly desirable food items, completely unknown before the discovery of the Americas. Among them are potatoes, tomatoes, corn and pumpkins, all excellent sources of nutrition. Unfortunately, tobacco is one item we would have been much better off without.
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