Here’s why the U.S. surgeon general and WHO want smokers to quit, asap

adamsmug-150x150Cigarette smokers got yet more chiding from public health officials about why and how they should quit an addictive and destructive habit. To do so isn’t easy, and a “shocking” number of doctors aren’t helping enough, the Surgeon General of the United States conceded. But there are big reasons to give up the nasty vice, especially before elective surgery, the World Health Organization warned.

The health experts found much to agree on when it comes to the carnage smoking causes. As the New York Times reported on the surgeon general’s work:

“More than 55 years after the first surgeon general’s report warned that smoking causes cancer, it remains the leading cause of preventable death and disease in the United States. According to the Centers for Disease Control and Prevention, the rate of smoking in the United States has declined to an all-time low of 14%. More than 3 of every 5 adult Americans who have smoked have quit, the report said. Still, 34 million Americans currently smoke, and an estimated 480,000 die from smoking-related illnesses each year, the agency said. About 16 million people in the United States now suffer from cancer, heart disease and smoking-related disorders, according to the CDC. The financial toll is enormous too, with annual health care spending attributed to smoking exceeding $170 billion, the agency said.”

Jerome Adams, who, as Surgeon General, serves as the nation’s top doctor, urged smokers to quit, urgently, and he cited federal research that shows the benefits for doing so, as the newspaper reported:

“[Q]uitting smoking is beneficial at any age, and can add as much as 10 years to life expectancy … the Food and Drug Administration has approved numerous medications for smoking cessation, including the nicotine patch, and other nicotine replacement therapy, and that these can be most successful when used in combination, especially with behavioral counseling.”

But quitting isn’t easy, and doctors, especially, must step up to do more, Adams said. He told the New York Times in an interview:

“Forty percent of smokers don’t get advised to quit. That was a shocking statistic to me, and it’s a little embarrassing as a health professional.”

Doctors and public health officials need to increase their efforts significantly to help select groups battle tobacco’s harms, because they smoke at disproportionately high levels and suffer a range of diseases, as a result. The groups include “gay and transgender people, Native Americans, people with mental illness diagnoses and several other groups with high smoking rates,” the newspaper reported.

Adams based his latest anti-smoking campaigning on data collected in a 2015 national health survey and analyzed in a 700-page surgeon general’s report.  

It included another important takeaway worth emphasizing, as the New York Times reported: “[E]-cigarettes, which are a diverse and constantly changing group of products, haven’t yet been proven to be effective” in helping tobacco smokers to quit. More on this point in a second.

The world health body, separately, made a point in its anti-tobacco campaign as to how doctors can and should make elective surgeries a “teachable moment,” helping patients facing a serious medical procedure better grasp the benefits of a tobacco-free life.

As the New York Times reported on the virtues here of stopping smoking:

“It goes without saying that cigarettes and surgery are not a winning combination. Scores of studies have shown that patients who use tobacco have poorer post-surgical outcomes. But many doctors give smokers conflicting advice on the ideal length of time they should go cold turkey before their operations. A new report released this week by the World Health Organization seeks to provide some clarity. Patients who quit smoking at least four weeks before an operation, the study found, have substantially improved outcomes, with fewer post-surgical infections and a reduced probability that they will have to return to the hospital for additional care. The authors of the WHO report, which reviewed more than 100 studies on the subject, hope their findings will serve as a clarion call to the surgeons, anesthesiologists and hospital administrators who can play an outsized role in convincing patients to kick the habit, both temporarily and for good.”

The newspaper article had other excellent reporting, worth quoting:

“There are more than a billion smokers globally, and one in 25 undergo major surgery each year, according to the WHO. In wealthier countries, as many as 16% of post-surgical patients develop severe complications; in the developing world, the post-surgery mortality rate can reach 10% depending on the country. Studies have found that smokers who undergo surgery have more than double the rate of complications compared to nonsmokers, posing a significant burden on hospitals around the world …. The authors of the report said the findings provided a powerful case for doctors to delay elective surgery for smokers to give them more time to quit. They found that patients who stopped smoking a month before surgery had fewer complications six weeks later, and that every tobacco-free week beyond those four weeks improved health outcomes by 19%. The dangers of tobacco are widely understood, but few people appreciate the disadvantages that smokers face when recovering from a hip replacement, open-heart surgery or even a face lift. Smoking adversely affects cardiovascular function and the ability of tissues to heal. That’s because the carbon monoxide in cigarette smoke reduces the oxygen needed for normal cell function. Nicotine is also thought to stymie the clumping of the blood platelets that aid healing. ‘Surgery itself is an assault on the body and your recovery is going to be that much harder if you smoke,’ said Dr. Kerstin Schotte, a medical officer at the WHO, who works on tobacco control and helped write the report.”

In my practice, I see not only the harms that patients suffer while seeking medical services, but also the significant benefits they can enjoy by staying healthy and far from the U.S. health care system. It has its own serious problems with medical errorpreventable hospital acquired illnesses and deaths, and misdiagnoses. Avoiding smoking is a leading way to keep away from these kinds of harms.

If you don’t smoke tobacco or use e-cigarettes, please don’t start. One of the key “pleasures” of both smoking and vaping, users and experts say, derives from the effects of addictive nicotine. E-cigarettes, promoted by too many as a way to quit tobacco, has, instead, shown itself to be a gateway to regular cigarette smoking. The fancy devices also are designed to deliver a wallop of nicotine, a substance that studies show is harmful to the cognitive development of the young. It also sinks its hooks into users, who find it a terrible craving to kick.

Big Tobacco, and now the vaping industry, have shown themselves to be wily, deep-pocketed, and stubborn competitors for markets of gullible users. No one has ever stood up and shouted that vaping is beneficial to anyone — just that it is a less harmful pastime than some others (tobacco use). That’s hardly a ringing endorsement.

Adams is right to say that evidence now is lacking for claims that e-cigarettes help tobacco smokers quit. More study may be merited. This also should include rigorous study of marijuana use and individuals’ health, particularly as evidence grows that, just as with tobacco abuse, grass smoking may be injurious to those with heart disease.

In the meantime, the federal Centers for Disease Control and Prevention deserves criticism for pulling from its online materials its broad warning to the public to stop vaping for now until more information could be developed on the cause of last year’s outbreak of vaping-related deaths and serious lung injury cases. As of Jan. 14, the CDC has reported 60 deaths and 2,668 lung-damage hospitalizations tied to e-cigarette use.

The agency has expressed growing certainty that a central cause of the vaping outbreak appears to be tied to street products tainted by Vitamin E acetate, used as a supplement or extender or occurring as a taint. Many of the cases also involve vaping of tetrahydrocannabinol or THC, the key component that gives users a marijuana high.

Even if the agency is closer to solving why extreme cases of harm occurred due to vaping, its leaders cannot pronounce the practice safe or healthy, right, so why not attack it as public health officials long have done with tobacco abuse?

The answer, of course, may be coming from the Oval Office. President Trump, news reports say, is furious with Alex Azar, the head of the giant, federal Health and Human Services agency for persuading him to be part of “that [expletive deleted] vaping thing.” Trump, facing impeachment in the Senate and a tough reelection campaign, is reportedly unhappy that his political standing may be hurt by opposition from Big Tobacco and the vaping industry.

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