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Preventitive Medicine: Smoking
Cessation and Prevention - RCJ
Prior
to the late 1800’s, tobacco use in the United States was
limited to cigar and pipe smokers. A new method to cure
tobacco made cigarettes possible, and with the advent of the
technology of mass production, the use of cigarettes began
to increase. By the early 1900’s, the per capita consumption
of cigarettes had begun to skyrocket, but it was not until
20 to 30 years later that the profound health effects became
evident. The first reports of a serious increase in
illnesses related to cigarette smoking began to appear in
the medical literature in the 1940’s and 50’s. The first
Surgeon General’s report on the adverse consequences of
smoking was published in 1964 and has been followed by more
than 20 subsequent reports describing the serious health
care problems related to smoking.
Every
day, new headlines proclaim the dangers of cigarette
smoking, new regulations or changes taking place in the
industry. We hear on a daily basis the reasons why we should
stop smoking or stop surrounding ourselves with people who
smoke.
Tobacco-related illnesses are overwhelming our
population. These illnesses include heart disease, stroke,
other vascular diseases, a variety of cancers, and chronic
obstructive pulmonary disease. In the United States, nearly
half a million people die annually from the direct or
indirect effects of smoking. Smoking is the most important
preventable cause of death. Tobacco alone causes more deaths
than alcohol, cocaine, heroine, murder, car accidents and
AIDS combined.
In
addition to its adverse health consequences, cigarette
smoking carries an enormous economic burden. It accounts for
a substantial and preventable portion of all medical care
costs in the United States. The direct medical care cost
attributed to smoking in 1993 reached $50 billion. These
estimates, however, underestimate the overall costs of
cigarette smoking. For example, they do not include other
direct medical costs, such as burn care resulting from
smoking-related fires, perinatal care for low-birth-weight
infants of mothers who smoke, and costs associated with
diseases caused by exposure to environmental tobacco smoke
(second hand smoke).
The
indirect, non-medical costs due to smoking is over $47
billion - nearly as much as the direct medical
expenses. These include the cost due to lost productivity
and missed work, higher insurance cost, and higher costs in
businesses where employees are allowed to smoke. Employers
absorb a considerable portion of these costs. Cigarette
smokers are absent from work approximately 6.5 days more per
year than nonsmokers. They make about six more visits to
health care facilities each year when compared to
nonsmokers, and their dependents utilize the health care
system about four visits more per year than the dependents
of nonsmokers.
Smoking
was once considered merely an unhealthy habit that was
largely a matter of personal choice, it is now widely
recognized by the American Psychiatric Association and fits
their criteria for substance use disorder. The latest
research in the biology of nicotine addiction suggests that
the drug-addicted brain is qualitatively different from the
non-addicted brain.
Nicotine is considered the chief addictive component of
tobacco. Like other addictive drugs, nicotine is thought to
affect the reward and withdrawal pathways of the brain. The
addictive properties of nicotine are functionally similar to
other drugs that are known to be addictive, including heroin
and cocaine. However, nicotine addiction has several unique
features. It can be a particularly reinforcing drug because
of the rapid effect it produces when it is inhaled.
Approximately 90% of the nicotine absorbed in the lung
reaches the brain within 10 seconds after inhaling.
Until
recently, all of the aids to help smokers quit provided some
other form of nicotine delivery system (patch, gum, or nasal
spray) to replace the nicotine otherwise obtained from
tobacco products. The Food and Drug Administration (FDA)
recently approved a non-nicotine aid to smoking cessation in
the form of a pill. Zyban (bupropion HCl) is an
antidepressant which affects both the reward and withdrawal
pathways in the brain.
When a
smoker quits, certain levels of neurotransmitters in these
two areas of the brain decline, helping to produce
withdrawal symptoms. Zyban diminishes some of these
symptoms. This new therapy remains one of many tactics
smokers can use to help them “kick the habit.”
Smokers
who quit improve their health status and can have a profound
impact on specific diseases, including a variety of cancers,
premature coronary heart disease, and other vascular
disorders. For example, in former smokers who have not
smoked for 10 years, the risk of lung cancer is about 30% to
50% of the risk for those who continue to smoke.
The
risk of cancers of the oral cavity and esophagus is halved
after 5 or more years of abstinence. The risk of bladder
cancer is reduced by half after only a few years. Smoking
cessation also results in substantial reductions in the risk
of stroke, as well as in the risk of developing peripheral
artery disease.
While
treating smokers today remains the primary focus for
physician, prevention is still the key. Smoking is on the
rise among youngsters under 18, according to the American
Cancer Society, increasing 30% in the last six years. The
global tobacco settlement would partially address these
issues - by eliminating cartoon characters that appeal to
the young, such as Joe Camel - but more must be done.
Physicians are in a unique position to help smokers
quit. Smokers represent over 25% to patients coming in for
office visits and more than 70% of smokers see a physician
each year. Physicians must help their patients deal with the
addictive nature of tobacco.
Smoking
imposes an enormous cost, in terms of health, as well as
economic factors. Both preventive measures and treatment
methods are essential to minimize the degree of
suffering and the economic burden on society.
Content
of articles can only be used with writer attribution to Dr.
Kevin Weiland.
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