They come in, saying, “I have a cold.”
“What do you mean by a cold? Different people mean many different things by that word. Tell me exactly what kind of problems you are having.”
The patient now is getting exasperated. “I have a cold. I have a cough. My face is always congested. (You may add in here any assortment or collection of the following symptoms, and many others: sinus congestion, sinus drainage, pressure in my face, headaches, migraines, sore throat, shortness of breath, fullness in my chest, don’t feel good, tired all the time, don’t have any energy, can’t sing like I used to, can’t climb hills, get winded on the stairs, can’t go hunting, chest congestion, can’t sleep because of coughing, sometimes spit up blood.) The list is long and occurs in all combinations.
“Are you smoking?”
“I don’t smoke very much. I have cut way back. I used to smoke 2 packs per day, but now I only smoke 6 cigarettes a day.”
“Do you understand that all of the problems you are now having are because you smoke?”
“It can’t be that. I’ve been smoking for 30 years, and never had these problems before. It’s just because I have a cold. I need an antibiotic to get over it.”
“An antibiotic may help temporarily in some cases, but it won’t last. The reason you have all these problems is because your smoking has finally caught up with you, as it does eventually in everyone. The lining of your lungs and sinuses is injured from those years of smoke exposure, and will pick up any virus or bacterium in the vicinity very easily. You will continue to have these problems, and frequent infections, until you are able to give up smoking.”
“I’m sure it’s not that. I just need something to help me get over this cold.”
“Okay. I don’t believe so, but let me check you to make sure there is not something else going on. Then we can decide what to do.”
Sometimes there is something else found, such as otitis, requiring an antibiotic, or wheezing, requiring an inhaler, but most of the time, not anything other than the usual.
“The lining of your nose is inflamed and swollen. That same lining is in your sinuses and in your breathing tubes. What is happening in your nose is what is also happening in your sinuses, in your throat, and in your lungs, causing your cough, sore throat, headaches, nasal congestion, shortness of breath, and lack of energy. There is no medicine that can overcome this problem long term. The only way you can overcome these problems and feel better again is to stop smoking completely, and avoid all second hand smoke exposure as well.”
“I’d like to stop smoking, but I’ve tried, and nothing works. “I’ve tried the patches, the gum, and the pills, and nothing made me stop smoking.”
“Unfortunately, there is no medicine that will make you stop smoking. You have to want to stop smoking badly enough to stop. It’s all a matter of will power. No one ever said it was easy. You have to go through withdrawal, which is painful. But if you do stop, you still have the chance to have a full, long and productive life. If you do not stop at this time, your life will be short, you will gradually become more congested and short of breath, you will have frequent pneumonia, you will never have good energy, and you will gradually become oxygen dependent, unable to do any of the things that you enjoy most in life. It is your choice. I cannot do it for you, and no one else can either. We have smoking cessation classes for you if you wish to use them, and will supply patches for you free, if you attend those classes. At this point, it is all up to you. Only you can get a better life for yourself. “
There is at this point usually a pause for a moment of reflection, and then a response which is sometimes positive, indicating a real desire to tackle this problem and get better. Most of the time, unfortunately, it is some form of excuse, meaning only that these respiratory symptoms will not only continue, but gradually get worse, until life becomes miserable. Later, they come in to the office on oxygen continuously, still smoking, even though they are at great risk of setting themselves and their house on fire. They cannot go anywhere without lugging an oxygen tank with them. They cannot do anything without being short of breath. They cannot sleep because they are forced into a sitting position, or are coughing too much in spasms to sleep any length of time. Their life is miserable and short, and they are a burden to the rest of their family, their society. It is a slow and miserable suicide.
I struggle to understand why anyone would choose to do this to themselves. It is not just the matter of being sick all the time and not being able to breath. Smoking increases your risk of cancer of the lung exponentially , and increases your risk of cancer of the esophagus, stomach, colon, bladder five times normal. It shuts down the arteries to your legs, your heart and your brain, causing vast numbers of strokes, heart attacks, vascular bypass surgery, with associated morbidity, and sometimes causes loss of limbs. It causes death 10 to 20 years earlier than normal because of all these complications. It is terribly expensive, a great loss of income that could otherwise be directed toward savings or greater enjoyment of life. It causes asthma, and causes chronic illness amongst those children who are constantly exposed to second hand smoke. It causes secondary smoke exposure cancers amongst those who are closest to us and dearest to us. It causes house fires and forest fires. It is one of the most pervasive evil human exposures that has been permitted in our societies. Why we continue to permit this great source of misery and disease is a great question.
We believe in a free enterprise system, where any business should be able to promote its wares without interference from local, state or federal government. This libertine development of resources and products has made us the most prosperous nation in the world. We are loath to chastise any company for promoting their product. We are particularly loath to chastise an industry which has dominated our social environment for the past century. We all smoked. We all watch the movies where the greatest actors in the world puff on their cigarettes as they dally in sexual innuendos and male posturing, business decisions and government action, luring us in adventurous locales. We believe any business should have a chance to prosper and grow, and advertise as they best see fit. We believe in “caveat emptor.” We think that if any one of us buys a product which harms us, and we know it will harm us, it is our fault, and not as much the fault of the seller. Each of us should have the sense to know what is good for us and our lives, and act accordingly. We can’t blame companies for selling us a product which harms us, can we, if we know it will cause harm and we want it anyway, buy it anyway?
Although this attitude in the past has been to not blame manufacturers of disease causing products, because it is our fault we bought them, more enlightened members of our society have come to realize that there is immense duplicity involved in condoning products that cause death, injury, destruction, misery, greatly shorter lives, and cause an immense drain on the health care system. The latter point is the one which has finally convinced us we should do something about the tobacco industry. When we cannot care for the amount of disease which exists today in our society, are going bankrupt trying to take care of health care costs, don’t have health care coverage for millions of Americans, which means all the rest of us pay for their ER visits, and have a national debt which threatens to bury us as a nation, those who care the most understand that it is time to draw a line in the sand. No more. Those tobacco company executive who appeared before the Senate investigative committee and said, “I do not believe that tobacco is addictive,” should be denigrated, fined and thrown in prison. They lied to themselves, knowingly, and the entire society which buys their products. They knew better, but lied anyway, in order to put more money in their own pockets. They were scum.
There is plenty of precedent. We don’t condone heroin, cocaine, black tar, “vics,” “percs,” “adds,” on the streets. We do not allow marijuana without a prescription. We don’t condone murder, rape, incest, robberies, childhood predators, public inebriation, genocide, violence without cause. What are we waiting for: Christmas, Nirvana, the Second Coming, Paradise?
Wake up, America. It is time to put a stop to one of the greatest diseases in our society. Either outlaw tobacco, or tax it to death. It is an immense societal evil