The
information in this column is intended for informational
purposes only, and does not constitute medical advice or
recommendations by the author. Please consult with your
physician before making any lifestyle or medication changes, or if you
have any other concerns regarding your health.
SMOKING
& QUALITY OF
LIFE
Denial is
generally not looked upon as a positive trait. When
people engage in denial about lifestyle habits
that are likely to expose them to great potential harm, however, the
consequences
of denial can be especially severe.
Unfortunately,
smoking, the single greatest cause of preventable illness and death
throughout
much of the world, is often associated with considerable denial.
Even
conservative
estimates suggest that nearly half a million premature deaths occur
every year
in the United States
due solely to smoking tobacco. Lung
cancer, the number one cause of cancer-associated death in this
country, afflicts
more than 215,000 new victims every year, and causes more than 160,000
deaths
per year (currently, 85 percent of patients who develop lung cancer
will die of
this horrific disease within 5 years of their initial diagnosis). In addition to lung cancer,
tobacco use has
also been clearly linked to cancers of the oral cavity, larynx (voice
box),
esophagus, bladder, kidney, pancreas, stomach and bone marrow
(leukemia).
In
addition to
smoking-associated cancers, chronic lung diseases like emphysema and
bronchitis
also cripple and kill tens of thousands of smokers every year as well. Moreover, in addition to
the 35 million
Americans who currently live with chronic lung diseases (the vast
majority of
whom are smokers), tens of thousands die prematurely every year from
tobacco-associated coronary artery disease, peripheral vascular disease
and
stroke.
One
would think
that grim statistics like these would result in the elimination of
smoking from
the world in fairly short order. However,
more than four decades after the US Surgeon General declared smoking to
be irrevocably
linked to lung cancer, nearly 1 in 4 Americans continues to smoke (for
a more
thorough overview of lifestyle-associated cancer risks and cancer
prevention
strategies, please watch for my forthcoming book, “A Cancer Prevention
Guide
for the Human Race,” which should be completed in mid-2009).
When
I gently
remind patients of mine who smoke about these same smoking-related
health consequences,
and the importance of quitting, many of them will nod in agreement with
me that
they should indeed quit, although I already know that only a tiny
percentage of
them will ever achieve this goal. Another
common response is, “Hey Doc, we all gotta die of something!” This latter response is
usually said with a mischievous
smile, and the message, which is always very clear to me, is that I am
wasting
my time in trying to coax such patients into quitting.
It
is also clear
to me that many patients who smoke are indulging in a great deal of
denial,
preferring to believe that while they may indeed die a few years
earlier, they
are, at the same time, exchanging their nicotine-induced pleasures for
a reasonably
comfortable and healthy life until their time in this world is
prematurely up. Some
patients, having made their deal with the
devil that is tobacco, have actually tried to convince me that the
quality of
their lives will be improved by
their
decision to smoke as (or so they rationalize) they foresee themselves
dying
earlier, but in a state of better overall health because, in their
minds, they
will “go out” before the ravages and diseases associated with aging can
strike
them.
Most
of us who
care for patients with cancer, and for patients with other serious
chronic
illnesses, already know that death very often does not come quietly in
the
middle of the night to softly and humanely steal away smokers. But, short of chaperoning
smokers through
cancer wards, lung failure clinics, cardiac ICUs, and the like, it can
be
frustratingly difficult to convey to many smokers just how harmful
their
smoking habit is to the human body (on the other hand, after more than
20 years
as a physician, it is still always surprising to me to find smokers who
already
know that, on average, their lives will be cut short by an average of 7
to 10
years because of their smoking, and who nonetheless continue to puff
away!). Now, a
newly published prospective clinical
research trial, with extensive long-term follow-up, is painting a more
detailed
picture regarding the true health costs associated with chronic
smoking, and
with a particular emphasis on health-related quality-of-life issues in
smokers.
This
study was
completed at the University
of Helsinki,
in Finland,
and has just been
published in the Archives of Internal
Medicine. In
this prospective clinical
research study, almost 1,700 middle-aged men participated in the
Helsinki
Businessmen Study. At
the time that these
men enrolled in this study, in 1974, their average age was 48, and all
were in
good health. Subsequently,
after an
average follow-up of 26 years, a previously validated health-related
quality-of-life
survey was administered to all study volunteers.
Death rates, and causes of death, for this
group of patients were also evaluated, using mortality data from Finland’s
national healthcare system records.
Consistent
with
data from previous public health studies, the men in this study who had
never
smoked lived, on average, 10 years longer than the men who smoked more
than 20
cigarettes per day. Not
only did the smokers
die younger than the non-smokers, however, but contrary to what many
current
smokers would like to believe, the health-related quality-of-life was
significantly worse among the smokers, and as these middle-aged men
passed into
the latter years of their lives, the smokers’ health and
quality-of-life
continued to deteriorate far more dramatically than their
“never-smoking”
peers. In fact, the
more cigarettes per
day that were smoked, the more profound was the deterioration in
health-related
quality-of-life.
The
RAND-36 health-related quality-of-life
survey that was administered to the study volunteers contains 8
different areas
(or scales) of focus. In
all 8 areas,
the smokers rated their health and well-being as significantly worse
when compared
to the “never-smokers.” In
five areas,
the differences between these two otherwise matched groups of older men
were
especially striking. These
five health-related
areas included overall physical functioning, energy/vitality levels,
social functioning,
and two different measures of mental health and emotional health
well-being. Indeed,
this study determined that the active
smokers had levels of physical, emotional and mental disability that
were, on
average, comparable to “never-smokers” who were 10 years older in age! (An important related
finding was that,
despite the long duration of follow-up in this clinical study, former
smokers were
never quite able to catch up with “never-smokers” in terms of their
self-assessed
health-related quality of life, although they still fared better than
the men
who continued to smoke more than 20 cigarettes per day over the long
course of
this study.)
While only about
15 percent of the “never-smokers” died during the 26-year course of
this
clinical study, over 44 percent of the men who were smoking more than
20
cigarettes per day when they enrolled in this study in 1974 had died by
the
year 2000. And,
contrary to the
expectations of many current smokers, the quality-of-life of long-term
smokers
was uniformly and significantly poorer across important physical,
emotional and
mental health parameters when compared to a matched group of men who
had never
smoked. In light of
these findings, I shall
end this column much as I began it.
Denial
is, in general, not a desirable trait or behavior.
When the subject of one’s denial is focused upon
rationalizing the short-term and long-term costs of smoking, the
consequences
can be catastrophic, both for the smoker and for his or her loved ones.
If you are a
“never-smoker” who is thinking of
taking up this enormously addictive habit, then you can not only expect
to die,
on average, 10 years earlier than your “never-smoking peers,” but you
can also
expect to spend the latter years of your life with the physical,
emotional and
mental health disabilities of “never-smokers” who are a decade older
than you.
Oh, I almost
forgot to mention one
additional smoking-related disease. In
addition to all of the horrific smoking-related conditions that I have
mentioned thus far, smoking is
also the most common
preventable cause of impotence. If
you
are a young man who is thinking of taking up smoking, or if you have
already
started smoking, then you might want to watch the following public
health message
from the UK:
http://www.metacafe.com/watch/115545/smoking_causes_impotence/
Disclaimer:
As always, my advice to readers is to seek the advice of your physician
before making any significant changes in
medications, diet, or level of physical activity.
