Smoking, Lung Cancer, Death
There have been hundreds of studies conducted on nicotine and tobacco products to understand the combined physical and psychological impacts on people. As this chapter demonstrates, smoking and exposure to second-hand smoke are extremely hazardous to human health.
The history of the tobacco epidemic can be traced back several hundred years. In the late 1600s, Christopher Columbus observed that his sailors could not quit chewing and smoking tobacco. It’s one of the earliest commentaries on record about the addictive nature of tobacco—and this tobacco probably didn’t have additives like modern day cigarettes.
In 1761, one of the first tobacco-related health studies was released claiming a correlation between nose and throat cancer and snuff. In 1853, Dr. L.B. Coles, a physician in Boston, proclaimed that “Tobacco is a deadly narcotic.”
In 1893, the Washington State Legislature outlawed the sale of cigarettes. Shortly thereafter, several other states, including Iowa, Kansas, Tennessee and North Dakota followed the example because of negative health and social impacts. The negative sentiment cleared within a few years and the industry started rolling again.
By 1915, Americans smoked 30 billion cigarettes annually. By 1973, that number exploded to 600 billion. Over this same period, lung cancer deaths soared from 10,000 yearly to 140,000. Lung cancer rates in America increased at five times the rate of other forms of cancer between 1938 and 1948.
“The cigarette smoker is slowly and surely poisoning himself, and is largely unconscious of it,” said a professor from the New York School of Medicine, in 1911. In 1918, Tobacco and Human Efficiency was the first study published to discourage cigarette use.
Alcohol was outlawed in America in 1919 and tobacco was rumored to be next on the black list. Other than a few states, the national prohibition never advanced. In fact, the government soon made cigarettes a staple of war and doled them out to soldiers for years.
Meanwhile, the evidence of death and mayhem caused by tobacco products began to mount. In response, more cigarettes were made with filters and menthol. In 1931, the first cigarette filter appeared on the Parliament brand. By the early 1950s, only 10 percent of smokers used filter-tip cigarettes. By 1960, however, the number soared to 50 percent because of health concerns and the wishful belief that filters made smoking safer.
In 1952, the British Medical Journal editorialized that the mounting health evidence against tobacco surely called for intensive research to eliminate the harmful carcinogens. In 1954, the American Cancer Society published a report on smoking and mortality by Horn. By the 1950s, tobacco brands began competing on their ability to minimize health risks associated with smoke, nicotine and tar. This marketing trend didn’t last long because it hurt the image of the industry and eroded overall sales.
The January 1959 issue of Journal of the National Cancer Institute contained a 30-page article that powerfully summarized the anti-tobacco debate. It was authored by several of America’s leading cancer researchers. Meanwhile, the Eisenhower administration did not force agencies and staff to remain silent on their anti-tobacco views, so criticism continued to cause sparks.
About five million people die annually around the globe from tobacco, (a person dies about each second). The World Health Organization estimates the cost of tobacco-related illness worldwide to be $200 billion per year, not including lost income. One-half of all current smokers alive in the world today will die as a result of smoking—one in four before the age of 60 (losing an average of 20-25 years of life).
More precisely, a person in America dies every 13 seconds from tobacco-related illnesses—about 443,000 deaths per year. In addition, 500,000 Chinese, 38,000 Canadians and thousands of others around the globe die each year from smoking.
Of these tobacco-related deaths, about 500 Americans die every day from lung cancer alone—about 182,500 deaths annually. Colon/rectal is the next deadliest form of cancer, killing 54,900 Americans each year—less than a third of the lung cancer rate.
80 percent of health costs linked to tobacco usage
The annual cost of tobacco-related illnesses in America is estimated at more than $13 billion in direct medical costs and $37 billion in lost productivity. One estimate claims the cost is as high as $97 billion annually. Similar estimates can be extrapolated for all countries.
Cigarettes and second-hand smoke contain benzo(a)pyrene. When this compound enters the lungs, it forms a new compound—benzo(a)pyrene diol epoxide—which binds to and damages the gene p53. This damaged gene is one that protects humans from lung cancer.
In 2001, the Prevention Institute evaluated the issue and claimed that the most cost-effective health care investment is money spent on smoking prevention and cessation. The tobacco carnage is so bad that a surgeon at the Memorial Sloan-Kettering Cancer Center refers to the operating room as “Marlboro Country.” In addition to the lung cancer threat, smokers have a 70 percent greater chance of heart disease than nonsmokers. Plus, people with high blood pressure who smoke are at five times greater risk of having a stroke than people who are smoke-free. Additionally:
- Smokers are at a higher risk for throat, mouth, lip, tongue, stomach, uterus, bladder, kidney, pancreas, skin and breast cancer;
- Male smokers are more likely to be impotent than non-smokers, according to a study of 4,400 military men; “If you smoke, you are about twice as likely to have erectile dysfunction,” says Dr. John McKinlay, New England Research Institute. Many doctors feel that erectile dysfunction is a precursor to cardiovascular disease, which is often caused by smoking;
- Teens who smoke 20 or more cigarettes daily are more than 15 times as likely to develop panic disorder as adults, nearly seven times as likely to become agoraphobic, and more than five times as likely to develop generalized anxiety disorder than teens who smoked less or not at all, (Columbia University, November 2000);
- Regular cigar smokers are almost twice as likely as nonsmokers to develop cancer of the mouth, throat or lung, according to a study published in the New England Journal of Medicine in 1999;
- In 1996, 26.7 percent of teens 14-19 reported smoking a cigar during the previous year.
- The average cigar has carcinogens equal to 2.5 cigarettes, while larger cigars can contain the equivalent of an entire pack;
- The skin of smokers is 25- 40 percent thinner than nonsmokers;
- Smoking weakens bones and stunts growth;
- Cigarette smoke contains a bacterial toxin called endotoxin, which is a leading cause of bronchitis. One pack of cigarettes contains one-half of a milligram of endotoxin—the same exposure as working in a dusty cotton mill for eight hours;
- Smoking can lead to infertility in women. Smoke contains polycyclic aromatic hydrocarbons, which can kill a woman’s eggs;
- Smoking can reduce the birth weight of newborns;
- “Cigarette babies” are a more serious problem than crack babies or fetal alcohol syndrome babies;
- Women who smoke during pregnancy are 50 percent more likely to have a mentally retarded child and more likely to have a miscarriage. Furthermore, women who smoked during the last six months of pregnancy are 60 percent more likely to have mentally retarded children than women who do not smoke;
- Smoking doubles a person’s risk of developing dementia or Alzheimer’s disease;
- Smoking interferes with the body’s healing process after an injury or surgery. Because of this fact, some doctors at Toronto’s St. Michael hospital say they will no longer perform certain bone reconstruction procedures on smokers;
- Smoking can cause the early onset of menopause among women;
- Smoking is linked to a higher incidence of leukemia, asthma, bronchitis, pneumonia and emphysema;
- Smokers are more susceptible to influenza and more likely to experience severe symptoms when they get the flu;
- About 86 percent of children with Legg-Perthes disease (a formative disorder) live with parents who smoke;
- Smoking can lead to osteoporosis;
- Smoking diminishes strength, agility and balance;
- Depressed smokers are more likely to develop cancer;
- Free radicals in smoke are linked to heart disease and cancer;
- TSNA, NNAL, NNAL-Gluc are other cancer-causing chemicals carried in tobacco smoke. These chemicals stay in the body up to six weeks after smoking;
- Smoking forms A.G.E.s (a molecular glue that clogs arteries);
- Smoking by parents kills 6,200 children in the U.S. each year by causing respiratory and cardiovascular problems. Parental smoking kills more children than all unintentional injuries combined. Related ailments cost $4.6 billion to treat;
- About 250 children die each year from fires caused by cigarettes, matches or lighters.
- About 8,000 Americans are killed or disfigured each year by fires caused by cigarettes;
- Pet birds have died from inhaling tobacco smoke generated by their owners;
- Smoking contributes to sick building syndrome.
- In America alone, it kills 280 children from respiratory illness;
- It causes 30 times more lung cancer deaths than all regulated pollutants combined;
- About 3,000 American nonsmokers die each year from lung cancer and second-hand smoke causes 53,000 heart-disease deaths in nonsmokers;
- In 1996, the Center for Disease Control found that 88 percent of people had cotinine in their blood. Cotinine is a chemical that the body metabolizes from nicotine. Its presence in the body indicates that a person has been exposed to tobacco smoke over the last two or three days. The same study determined that 43 percent of children are exposed to tobacco smoke by people in their household;
- Nonsmoking spouses of smokers run a 20 percent higher risk of heart disease because they inhale the equivalent of 1.5 cigarettes per month in their home;
- Workers in smoking restaurants inhale the equivalent of two cigarettes per month;
- COT deaths have been linked to second-hand smoke (tobacco is linked to 60 percent of crib deaths);
- Smoking is responsible for 500,000 physician visits in the U.S. each year for asthma and 1.3 million visits for coughs; and
- Smoking causes more than 115,000 episodes of pneumonia and 260,000 cases of bronchitis in the U.S. each year.
Attempts to develop “safer” cigarettes by tobacco companies were initiated then abandoned because they implied that regular cigarettes are dangerous. Ariel was a brand that heated but didn’t actually burn the tobacco. Premier was RJR’s smokeless cigarette and Phillip Morris developed Accord. Brown & Williamson even considered using a tobacco with fewer carcinogens. It also briefly considered making cigarettes without nicotine or additives. Of course all of these ideas were scrapped and it was back business as usual.
In 1957, the Surgeon General reluctantly issued a loose statement about tobacco. The report read, “…the weight of the evidence is increasingly pointing in one direction…that excessive smoking is one of the causative factors in lung cancer.” Surgeon General Burney was a smoker.
Since then, there have been 23 Surgeon General Reports on the dangers of smoking—each getting stronger and more defined. Surgeon General Luther Terry authored the next report on January 11, 1964. Dr. Oscar Auerbach found the first link between cancer and smoking in the early 1960s and it led to the report “Cigarette smoking may be hazardous to your health.”
In 1971, cigarette labels were strengthened to read, “The Surgeon General has determined that smoking is hazardous to your health.” Tobacco ads were banned from television that same year. The 1989 report connected smoking with lung cancer. The Surgeon General even issued a youth version of the report in an attempt to discourage youth smoking.
The health insurance industry has calculated the risks of smoking for years. They charge higher premiums for smokers because of the quantifiable risks and costs of smoking.