The largest health problem in America is the smoking of cigarettes. No single action, habit, or activity by our citizens causes more misery, disease, loss of income, and loss of life than smoking. You'd think that knowing this, no one would EVER pick up a cigarette. Would that that were true! But, it's not true, so let us talk about the scope of the problem and offer solutions to it.

            Smoking causes disease through the three main types of chemicals contained in the smoke. First, there is nicotine. The feeling that nicotine gives you is the main reason people smoke. Whether people tell you that they smoke out of habit or boredom, if they're taking in over 3 to 5 milligrams of nicotine a day, they're hooked on the drug. Nicotine gives a pleasant "high", like that first drink of alcohol at the end of a long day. It relaxes a person, focuses attention somewhat, and, of course, stops the nicotine craving. It is also very habit-forming and causes withdrawal symptoms when one stops smoking.

            While smokers might not even be aware of the drug effect after many years, the regular ingestion of the above amount, found in about 5 Marlboro cigarettes, is enough to cause a dependency on nicotine. Nicotine also accelerates the heart rate, which causes wear on the heart and blood vessels, increasing the risk of stroke and heart disease. Finally, nicotine may cause "vasoconstriction", which closes off the blood vessels to the heart and increases the chance of heart attack.

            Second, there is carbon monoxide. This odorless chemical is the same stuff found in car exhaust and results from the burning of tobacco leaves. It drives oxygen off of red blood cells and increases the chances of heart attack, stroke, hypertension, and probably aneurysm formation.

            Third, there is tar. Tar is the black stuff one sees on the end of a filter after smoking a cigarette. It is composed of chemicals not unlike road tar. Cigarette tar is one of the most cancer-causing substances known to mankind and is very dangerous. Also, tar builds up in the lungs, causing the inflammation and tissue destruction which lead to emphysema.

            The combination of nicotine, carbon monoxide, and tar in that small paper tube that is sucked on by about a fourth of the American population assaults the health of the body. A regular smoker has a distinctly higher risk of heart attack, as much as a four-fold increase. The chance of lung cancer is much increased, well over doubling the risk in some studies. Nearly all patients that smoke a pack a day or more for over twenty years have developed some amount of emphysema. Essentially all lifelong smokers develop moderate to severe emphysema. This means that they end their lives smothering.

            Why do people start smoking? In my twenty years of medicine I have seen that by far and away the most common cause of someone starting to smoke is because his or her parents smoked. When I give talks to grade school classes around the county, I always at some point ask the children "how many of your parents smoke cigarettes?" Ever since I began doing that, always and without fail about half of the children raise their hands.

            When children are around their mommies and daddies and watch them smoke, it is quite natural that they become accustomed to the smell and mannerisms of their parents. It is as natural as learning what to eat that kids pick up the habits of their parents. If their folks drink booze, so do the kids. If they eat fattening food, so do the children. If they smoke, so do the little ones.

            It is one of the great moral and ethical problems of our country today that "mommies and daddies" will knowingly smoke cigarettes around their kids in the full realization that their children will probably pick up the disease. How selfish and stupid that parents will smoke in front of their children knowing that they are condemning their children to die a generation later choking for air and rotting of cancer due to a miserable habit that they cannot break which they got at their parents' knees! If there is an agreeable definition of a sin, this is surely one.

            Have you ever watched someone die of lung cancer? Many of my patients have faded away in front of me of the disease, almost all of them smokers. The pain is terrible, sharp and stabbing with every breath. The coughing of blood; the wasting away; the listless loss of energy usually leading straight to death. It is a sad sight, especially because it was so often a preventable death.

            And how about emphysema? Haven't you watched friends of yours or someone you know struggling to breathe, living on oxygen tanks and always so short of breath he or she is suffocating? Watch them carefully and see how pleasant it really is!

            If you are smoking a pack per day, you are choosing RIGHT NOW the diseases that will likely cause your death.

            Every single discussion you see in medical journals about the habit of smoking will relate that fewer than 1 in 10 people that ever develop a regular smoking habit will be able to stop. Without exaggerating, smoking is a dangerous and deadly disease largely given by parents to children that can rarely be cured and is usually fatal.

            The most reliable cure: Never start! For those with the disease, in the next paper I'll talk about my method for stopping and for limiting the impact of the disease. See ya there!