At age 34, I was a doctor on the faculty at Duke University School of Medicine, my first real job after completing my post-graduate training at UCLA (1960-62), Albert Einstein College of Medicine (1962-1964) and the National Heart Institute of the NIH (1964-1967). I had smoked a pack a day since my early teens. I had started smoking at the end of World War 2. With our troops returning home, cigarettes were available in great abundance again for the civilian population. The tobacco companies were ready to take advantage of this pent up demand. The returning troops already had a permanent tobacco habit and they felt gratitude for all the entertainment they had enjoyed near the front lines, sponsored by (you guessed it) the tobacco companies.
Everyone in my family smoked and most of my friends and their parents likewise. Smoking was "normal" in those days and the ubiquitous advertising for tobacco was enthusiastic, seductive, compelling and unrestrained. No one thought ill of a doctor who smoked. In fact cigarette ads sometimes featured doctors recommending certain brands.
Remember when an ad in Life proudly proclaimed, "9 out of 10 doctors prefer Camels."?
"It was found and reported by eminent doctors who compared the leading favorite cigarettes: SMOKE OF THE FOUR OTHER LEADING POPULAR BRANDS AVERAGED MORE THAN THREE TIMES AS IRRITATIING - AND THEIR IRRITATION LASTED MORE THAN FIVE TIMES AS LONG - AS THE STRIKINGLY CONTRASTED PHILIP MORRIS!"
While I was a junior in High School medical science finally got involved. Neither I nor my friends and family took any notice. It would be more than a decade, and many more scientific studies linking smoking and human disease and premature deaths before society began looking at the problem more carefully. Here is the first study and the young doctor who started the revolution.
In 1950, the year he graduated from medical school, Ernst Wynder, teaming up with a thoracic surgeon, wrote the first ever medical/scientific paper documenting the evils of tobacco products. (Wynder EL, Graham E. Tobacco smoking as a possible etiologic factor in bronchiogenic carcinoma: a study of 684 proven cases. JAMA 1950;143: p329)
In 1968 I was unaware of this or any other studies linking smoking and disease. I had a pack a day habit, my wife and kids didn't complain and none of my colleagues nor my patients seemed to mind either. Then I got bronchitis, twice over the course of a few months. The second time I was home in bed, the doctor made a house call, started me on antibiotics and strongly urged me to quit smoking. I looked at him as if he had just told me to stop having sex.
Although it made sense that inhaling smoke all day long might lead to irritation of the lungs I had never really considered that before. When I got a "cold" I would temporarily switch to mentholated "Kools". (I had learned that trick from my Dad.) To be truthful, smoking Kools makes even less sense than smoking regular cigarettes, but as a kidney specialist I admit that I had great gaps in my medical knowledge base.
Over the next few weeks I considered my options and finally decided to proceed. There were no programs, aides or drugs of which I was aware to assist me. It was common knowledge that stopping smoking was very hard to do. I did it anyway. Since the day I quit I have never had another cigarette. For many weeks, perhaps months I had urges to have a cigarette but never gave in to those urges. I do not know why I was successful and so many others are not. I have read that the average person quits 8 or 9 times before being successful. Since some quit on the first, second or third try, that means a few must try 15 or twenty times before succeeding permanently. I have known people who quit for years and then started up again. How demoralizing that must be for them.
Although many tobacco companies now actively promote stopping smoking I would not be surprised to learn that they still enjoy respectable profits. I have heard that many young people are taking up the habit at least in part to piss off their parents and teachers. It is debatable whether tobacco or illegal drugs are more harmful. I have read that marijuana does not cause lung cancer. I have never seen a patient in the hospital (where I worked for the last 12 years) with marijuana induced lung problems. I have seen many 100's of patients dying of chronic emphysema and bronchitis (COPD) due to smoking. There are few ways of dying that are more miserable than COPD. Lung cancer is one of them.
Here are some websites that will help you quit this nasty and ultimately fatal habit. I'd like to tell my patients, "If you insist on continuing to smoke, don't even bother to fasten your seat belts when you drive. Dying in an auto accident is a hell of a lot easier and quicker than dying of Chronic Obstructive Pulmonary Disease."
http://www.whyquit.com/ Ready to quit smoking and end all nicotine use? Almost 90% all long-term ex-smokers quit smoking cold turkey. Learn their quitting secrets! A quit smoking motivational site that should be seen by every tobacco user and teenager. E-mail this link to a friend who smokes. http://whyquit.com/whyquit/ scary and shocking pictures.
http://www.pmusa.com/en/prc/index.asp Parents can be the greatest influence on their children's decision not to smoke. Kids whose parents repeatedly talk to them about not smoking are significantly less likely to smoke. That's why Philip Morris USA Youth Smoking Prevention has supported the development of this online Parent Resource Center to help parents talk to their kids about not smoking.
http://www.ucanquit2.org/ Quit Tobacco—Make Everyone Proud is an educational campaign for the U.S. military, sponsored by the U.S. Department of Defense. The mission of the site is to help U.S. service members quit tobacco—for themselves and for the people they love. They offer live on-line help from a coach.
http://www.pmusa.com/en/prc/activities/downloadresources.asp Raising Kids Who Don't Smoke is a series of publications, comprised of English and Spanish-language materials, developed for parents of kids 10-17 to encourage and help them talk to their kids about not smoking.
http://pda.ahrq.gov/consumer/qscit/qscit.htm This program is a PDA tool that helps consumers to prepare to quit smoking. Included is a 5-day countdown to their quit date that can be inserted into their Calendar, as well as a number of helpful resources.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4843bx.htm Researcher, educator, and activist Ernst Wynder, MD (April 30, 1922-July 14, 1999), dedicated his career to producing this evidence. In 1950, the Journal of the American Medical Association published Wynder and Graham's "Tobacco Smoking as a Possible Etiologic Factor in Bronchiogenic Carcinoma: A Study of 684 Proven Cases." Wynder and Graham's retrospective study was not the first to link smoking and cancer, but its sophisticated design, impressive population size, and unambiguous findings demanded attention and further research.
http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=22542 The mission of the American Lung Association® is to prevent lung disease and promote lung health. The American Lung Association® is the oldest voluntary health organization in the United States, with a National Office and constituent and affiliate associations around the country. Founded in 1904 to fight tuberculosis, the American Lung Association® today fights lung disease in all its forms, with special emphasis on asthma, tobacco control and environmental health.
http://www.fda.gov/Cder/Drug/infopage/varenicline/default.htm FDA ALERT [2/1/2008] FDA is issuing this Alert to highlight important revisions to the WARNINGS and PRECAUTIONS sections of the full prescribing information for Chantix regarding serious neuropsychiatric symptoms. Serious neuropsychiatric symptoms have occurred in patients taking Chantix. These symptoms include changes in behavior, agitation, depressed mood, suicidal ideation, and attempted and completed suicide
Here are some sites that recall the good old days when smoking was part of growing up.
http://www.chickenhead.com/truth Once upon a time, the rich, sweetly pungent smoke of tobacco offered more than dreary old diseases like emphysema and lung cancer. It promised sophistication, sex appeal, even longevity itself. Cigarette smoking from bygone years.
http://www.youtube.com/watch?v=Zz96ZXdy9qo More Doctors Smoke Camels Than Any Other Cigarette
http://www.smokersclubinc.com/ The United Pro Choice Smokers Rights Newsletter
Author: Cleaves M. Bennett MD FACP
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