Fall 2002

Life and Health

Breathtaking Proof

Bill Butler

Donna Butler

Despite mountains of evidence about the harmful effects of cigarette smoking, the death toll continues to rise as tobacco companies find new ways to push their products.

The cowboy’s athletic body, tanned features and ready smile captivated millions. He seemed to project the essence of healthy outdoor living, and his choice of cigarettes influenced a generation. Sadly, at least two of the actors who portrayed the Marlboro Man died from the effects of smoking. And so have a host of others, from the rich and famous to the poor and unknown: from George Harrison, Yul Brynner, Walt Disney, King George VI and Bette Davis to perhaps some of your relatives and ours. 

While scientists strive to find vaccines against devastating diseases such as AIDS, another plague stalks the earth. The smoking-related disease epidemic is massive, encompassing the entire earth, and difficult to fight because a powerful industry promotes it. The World Health Organization (WHO) estimates that there are approximately 1.25 billion regular smokers in the world, or one third of the global population over the age of 15. Tobacco is blamed for the deaths of about 4 million of these smokers per year, and the death toll is projected to reach 10 million per year by the 2030s—more than the combined number of deaths from malaria, maternity-related and major childhood conditions, and tuberculosis. 

Critics claim that the death toll from smoking cannot be accurately estimated because “smoking” never appears on public documents as a cause of death. However, the diseases that do receive official credit can be directly related to smoking by a multitude of studies showing the effects of cigarette smoke on the human body. 

One such study, published in the October 18, 1996, issue of Science, links cigarette smoke carcinogens to what they call “major mutational hotspots” in human lung cancers. Similar studies show links between smoking and other diseases, indicating that the figures cited for smoking-related deaths may not be so far off. In the United States alone, according to the U.S. Centers for Disease Control (CDC), smoking kills more than 430,000 each year—far more than alcohol abuse, motor vehicle accidents, suicide, AIDS, homicide and drug abuse combined. 

A study done by Oxford University, in collaboration with Chinese academics, indicates that one in three Chinese men currently under age 29 will eventually die of smoking-related disease. And WHO reports that in some parts of Eastern Europe, lung cancer rates in men are the highest ever recorded anywhere in the world. 

Needless Toll

The tragic deaths of those in planes hijacked by terrorists in September 2001 shocked the world. Yet the estimated death toll from smoking-related illnesses goes almost unnoticed, even though, as the International Tobacco Control Network points out, it is equivalent to four fully loaded jumbo jets crashing every day—with no survivors. The remarkable fact is that all these deaths are totally preventable. 

Many organizations promote measures to reduce the use of tobacco throughout the world. Most agree on what works; however, these efforts are not being widely implemented in most countries. 

According to George Alleyne, director of the Pan American Health Organization, “ample evidence shows that policy measures—such as higher tobacco taxes, the elimination of tobacco promotion, strong health information on tobacco packages, and the mandatory implementation of smoke free environments in public places and workplaces—reduce youth smoking initiation and help smokers quit smoking.” 

Such efforts are commendable and are indeed proving to be somewhat effective in the battle. However, the smoking issue has many facets and is complex, involving farmers and manufacturers, the consumer, the environment, health care and the economy. Central to the problem is human greed: tobacco companies try to maximize their profits, and governments strive to fill their tax coffers. 

In the end, the responsibility for arresting this plague must lie with the individual smoker. We cannot change others, but we can change ourselves. Perhaps the paramount question is whether we each bear a moral responsibility toward ourselves and one another as we share space on this planet. 

Turning a Blind Eye

The negative impact on health from the use of tobacco products is well known and well documented. 

Cigarettes contain dozens of cancer-causing chemicals. According to a report issued in June by the International Agency for Research on Cancer, a branch of WHO, tobacco smoke is even more cancerous than previously thought, causing cancer in many more parts of the body than was once believed. The report revealed that, for the smoker, the risk of certain types of cancer is actually elevated five to six times (rather than three to four times) over that of the nonsmoker. In addition, other types of cancer once thought to be unrelated to tobacco have been added to the list. These include cancer of the stomach, the liver, the cervix, the uterus, the kidneys, the bone marrow and the sinuses. Already identified as smoking-related are cancer of the lungs, the mouth, the esophagus, the larynx, the pharynx, the pancreas and the bladder. 

The medical community has long held that smoking is also a major factor in coronary heart disease and stroke, and that it contributes to the severity of colds and pneumonia. In addition, studies have indicated that smoking has damaging effects on women’s reproductive health, increasing the likelihood of miscarriage, preterm delivery, stillbirth and infant death. In fact, smoking-related disease among women is reaching alarming heights in the United States, where women now account for 39 percent of smoking-related deaths each year. 

Most smokers are well aware that smoking is harmful to their health; after all, in many countries, that fact is printed right on the cigarette package. Yet many continue to smoke. Because the negative effects from smoking are not seen immediately but rather build up over time before the onset of emphysema, heart disease or cancer, some may think that it won’t happen to them. Others may take the approach that it’s their body, so they can do as they please. 

Are smokers really hurting only themselves? Is their own health the only issue?

But are smokers really hurting only themselves? Is their own health the only issue? 

For anyone who has ever had a loved one die of a smoking-related disease, the answer is a resounding no! Watching a mate, a child or a parent die by inches from cancer or emphysema produces an agonizing feeling of helplessness and despair. The untold suffering of 4 million families each year cannot be expressed in facts and figures. 

The Passive Approach

Smokers also need to consider the negative health impact that their habit has on those who choose not to smoke but are nonetheless exposed to tobacco smoke on a regular basis. Do smokers have the moral right to pollute the air that others must breathe? 

The U.S. Environmental Protection Agency (EPA) classifies secondhand, or passive, smoke (smoke inhaled by nonsmokers from other people’s cigarettes) as a known human carcinogen. According to the American Lung Association, more than 4,000 chemicals are found in secondhand smoke, of which 200 are classified as poisons and 43 as carcinogens. Citing EPA estimates, the association reports that passive smoking is responsible for approximately 3,000 lung-cancer deaths and 37,000 heart-disease deaths a year among nonsmokers in the United States. 

Research reported in the Journal of the American Medical Association in 2001 indicates that inhaling secondhand smoke for just 30 minutes can cause temporary damage to the heart. Clive Bates, U.K. director of Action on Smoking and Health (ASH), commented on the finding: “It is as if the blood vessels in the heart react suddenly to small doses of tobacco smoke—almost like an allergic reaction or spasm. . . . Passive smoking has a serious impact on the heart and is a real killer, not just a nuisance or irritation. . . . If something as hazardous as cigarette smoke was leaking from a pipe in a factory, inspectors would close it down, yet there are still 3 million non-smokers in Britain [who] are frequently or continuously exposed to tobacco smoke at work.” 

The January 1, 1991, issue of Circulation, the journal of the American Heart Association, records that one American dies from secondhand smoke for every eight who die from active smoking. A study of female nurses, published in the May 20, 1997, issue of the same journal, found that nonsmokers within the study group who were regularly exposed to secondhand smoke at work or in their homes had a 91 percent higher risk of developing coronary heart disease than those who were not subjected to smoke. 

Other studies indicate that parents who smoke may contribute to a wide range of health problems in their children. These include exacerbation of asthma, increased frequency of colds and ear infections, and sudden infant death syndrome. According to WHO estimates, 700 million—nearly half—of the world’s children are exposed to passive tobacco smoke. Smoking around children has been called the most prevalent and least reported form of child abuse. 

Smoke and Mirrors

Many smokers who are aware of the negative health impact of smoking on themselves and others do try to quit. Each year millions attempt it, but the vast majority fail. Mark Twain reportedly once said, “Quitting smoking is easy; I’ve done it thousands of times!” 

Mark Twain reportedly once said, “Quitting smoking is easy; I’ve done it thousands of times!”

Nicotine, an integral part of cigarettes, is the major active chemical component in tobacco. It causes pleasant mood-altering effects in the smoker’s brain that reinforce the continued desire to use tobacco. The chemical is said to be more addictive than heroin, though withdrawal symptoms are not nearly as severe or dramatic, of course. 

In spite of the tobacco industry’s persistent denial that cigarettes are addictive, company documents that have come to light in recent years indicate that they have known about the addictive properties of nicotine since at least the 1960s. A Brown and Williamson tobacco executive admitted in a 1963 internal memo that “nicotine is addictive. We are, then, in the business of selling nicotine, an addictive drug.” And an internal report written in the early ’70s by Philip Morris senior scientist William L. Dunn Jr. stated, “No one has ever become a cigarette smoker by smoking cigarettes without nicotine.” 

Because smokers not only become addicted to nicotine but also tend to link smoking with social activities, the habit becomes even more difficult to break. 

The first two weeks after quitting seem to be the most critical. Most would-be quitters who smoke even a single puff during those all-important first two weeks are soon back to smoking full-time.

Smoking Out the Culprit

With all the negative press that tobacco gets, why do people ever start smoking? A hefty part of the blame goes to tobacco advertising. According to the Federal Trade Commission’s “Cigarette Report for 2000,” issued earlier this year, the tobacco industry spent a record $9.57 billion in 2000 to get people to buy their cigarettes. 

After surveying internal documents from within the tobacco industry, most of which first came to light in the process of litigation, ASH made this assessment with regard to tobacco advertising: “The documents show that advertising is crucial in nurturing the motivation to smoke by creating or projecting the positive values, such as independence, machismo, glamour or intelligence, erroneously associated with the product.” 

As older smokers die, young people must be targeted to keep the industry alive. Most smokers start as teenagers: the American Lung Association estimates that 90 percent of smokers start smoking before age 21. In spite of repeated denials by the tobacco companies, their advertising and marketing are therefore geared to reaching the young. Tobacco advertising encourages young people, says the ALA, “to begin a lifelong addiction to smoking before they are old enough to fully understand its long-term health risk.” 

Another target group is women. According to CDC director Jeffrey P. Koplan, “the rise in smoking among women around the world has coincided with aggressive Western-style tobacco advertising. One of the most common themes used in developing countries is that smoking is both a passport to and a symbol of a woman’s emancipation, independence, and success. . . . We have firm evidence of a direct association between tobacco marketing and smoking prevalence.” 

A new and lucrative market has also opened up in the former soviet bloc. Industry analysts estimate that Western tobacco companies have invested between a half billion and 2.5 billion dollars in Russia alone. They have retooled old factories and repackaged old soviet brands, advertising heavily with familiar American symbols such as the Marlboro Man. 

Death and Taxes

Russia is not the only former soviet republic to be targeted. In the hope of influencing Czech fiscal and legislative policy relating to tobacco, industry giant Philip Morris commissioned a report “to quantify the effects of smoking on the public finance balance in the Czech Republic in 1999.” The report, which was prepared by management consulting firm Arthur D. Little in 2000, claimed that “public finance saved [an estimated] 1,193 million CZK [roughly US$30 million] from reduced health-care costs, savings on pensions and housing costs for the elderly—all related to the early mortality of smokers.” The report classified these savings as “indirect positive effects.” 

With regard to savings in health-care costs, the report said, “It can also be argued that the savings are even higher as the shortening of life means a reduction of the number of old patients, whose treatment is more costly than average.” 

The report eventually found its way back to the West, where it was met with a firestorm of protest. ASH director Bates commented, “The whole exercise is repellent and should be dismissed. Philip Morris is whispering in the ear of the Czech Government, saying, ‘Look, we can help you deal with those expensive old people, so why don’t you go easy on controlling smoking?’” 

The report proved to be a public relations fiasco for Philip Morris. A spokesperson for the company later apologized and called the commissioning of the study totally inappropriate. 

Clearing the Air

November 2002 marks the 25th anniversary of the American Cancer Society’s Great American Smokeout, an annual event that spotlights the dangers of smoking and challenges people to stop using tobacco. 

There are many health reasons to quit smoking, both for the smoker and for those around him or her. Those who want to live longer and healthier lives generally realize that it’s wise to conquer the habit (see What Are the Benefits of Quitting?” ). 

But health is not the only issue. There are moral reasons as well. Each one of us has a moral responsibility to act in ways that will preserve the comfort and health of others. Like the ripples that radiate from a pebble dropped into a still pond, everything we do affects those around us. From polluting the very air entering another’s lungs to being an example to those youths with whom we interact, we affect others. Even if we are willing to risk the personal consequences of the smoking habit, do we have the right to damage the lives of others? 

Even if we are willing to risk the personal consequences of the smoking habit, do we have the right to damage the lives of others?

Most people embrace the fundamental principle of love and concern for one’s neighbor. All Christians recognize the basic concept that we should love our neighbor as ourselves (Mark 12:31). They would agree with the biblical passage that is sometimes referred to as the Golden Rule: “Whatever you want men to do to you, do also to them” (Matthew 7:12). Is polluting the bodies of others with poisonous smoke showing the love and consideration expressed here? Is reducing your capacity and shortening your life fair to those who love you? 

God has made us in His image (Genesis 1:27) and He wants us to be happy and remain in good health. However, we must do our part. Is it right to satisfy our own desires for short-term gratification even at substantial harm to our health and long-term happiness, and that of others? 

For the ultimate benefit of everyone, why not kick the habit?