The Devastation of Smoking
And why we should treat smokers with compassion. And a few thoughts on vaping.
If I could make one recommendation that would change the healthcare landscape of America today, it would be for everyone who smokes cigarettes to stop. The effect, over just a few years, would be staggering in scope.
The list of illnesses attributable to smoking is long. Every day I see someone struggling to breath, their lungs damaged by chronic obstructive pulmonary disease (COPD/emphysema). Some people with asthma add smoking on top of their already perilous disease. If you’ve never been short of breath (and I have) you can’t imagine how horrible it is to be unable to move air in or out of your body.
I constantly see smokers with debilitating strokes that leave them weak, bed-ridden or dead. They have heart attacks, congestive heart failure and cardiac arrhythmias. Smokers lose limbs from poor blood supply, and smoking acts in concert with diabetes to worsen their other cardiovascular issues. They die too soon despite the heroic efforts of modern cardiologists, surgeons and the amazing technologies they employ.
And even as we make great strides in reducing cancer mortality, many varieties of malignancy are frequently induced (or their likelihood increased) by smoking. All too many years are stolen from far too many lives by cigarettes.
The lesson here is that we should regularly remind our loved ones (and ourselves) not to start smoking, and if already smoking, to try and quit. But we have to do this in love. Nicotine produces a powerful addiction. When I tell patients not to smoke, I always say, ‘I know, it’s very hard to do. But at least start by cutting back!’ There are many options available, from primary care physicians and public health groups, that can aid smokers in kicking the habit.
This is no place for moral grand-standing. Harsh judgement doesn’t change the powerful addiction of nicotine. ‘I don’t know why you just don’t stop,’ isn’t a great argument. And it’s often employed by people who daily abuse caffeine and eat too much, so there’s a bit of glass house problem there.
Furthermore, for many smokers with difficult lives and difficult or dangerous jobs, that hit of nicotine is one of the few true pleasures they have from day to day. We dismiss that far too easily. One of my sons, who recently worked with a number of smokers, posits that smoke breaks are a chance for stressed people to take a few minutes and just deep breathe.
Still, smoking, worldwide kills about 6 million people every year. In the US it’s about 480,000. That’s a lot of lives ended, a lot of families wounded and grieving, a lot of kingdom productivity lost to the world. It’s also a lot of long, slow decline as symptoms and diseases accumulate and interact to make daily life less and less pleasant, and to rob the afflicted of precious time and activities with loved ones.
It’s important that we encourage smokers gently and persistently, but with understanding, in order to help them to stop. I hope I live long enough to see smoking a thing of the past. And to see hospitals struggle with the problem of empty beds; at least empty of the people who would have filled them due to the consequences of tobacco.
(If you’re interested, here’s a fascinating look at vaping and its impact on smoking cessation. Not a commonly held view, but I’m intrigued.)
Here's a serious point about the economics of healthcare made by way of a bit of dark humor. In lectures, I've made the point (as have others) that the most effective means of reducing healthcare spending is to persuade as many people as possible to smoke--starting them at a very young age, if possible. This is because smokers tend to die before the really expensive illnesses of old age set in, and smoking-related illnesses have a habit of killing rather quickly, so there's no time to incur lengthy bouts of healthcare spending. Of course, some people defy these norms, but on average, it's largely correct.