"Slow-motion suicide"?

What is HEW Secretary Joseph Califano talking about when he refers to smoking as "slow-motion suicide"? During the past year, more than 650 billion cigarettes were sold in the United States. This aver ages out to more than 4,000 cigarettes per year—or more than a half pack per day for every person over the age of 18. More than a quarter of a million premature and unnecessary deaths occur each year in the United States because of cigarette smoking. Coronary heart disease, lung cancer, and emphysema account for the bulk of these needless deaths, but cancers of the larynx, mouth, esophagus, urinary bladder, and pancreas help swell the toll. Such malignant conditions as peptic-ulcer disease, stroke, and peripheral artery disease are found more frequently in smokers than in nonsmokers. More than 25,000 articles have appeared in recent years in medical literature, outlining in devastating detail the impact that cigarette smoking has on human health. In spite of this, there are still some who claim that the harmful effects of smoking still haven't been scientifically established. Let's look at the facts.

Smoking and coronary heart disease

Coronary heart disease is the most frequent cause of death in the United States. This is true for smokers and nonsmokers alike. However, smokers have a much greater risk of having a heart attack at a young age than do nonsmokers. The major ingredients of cigarette smoke most likely to be responsible for coronary trouble are carbon monoxide and nicotine. Carbon monoxide displaces oxygen from the hemoglobin of red blood cells (hemoglobin is responsible for trans porting life-sustaining oxygen to our body tissues). As a consequence, it is not uncommon for a heavy smoker to have 10 percent of his blood tied up with carbon monoxide. In order to distribute the normal amount of oxygen to the tissues, there must then be a 10 percent increase in the rate at which blood is circulated. The red blood cells have to make more frequent trips between the lungs and other body organs in order to deliver needed oxygen.

There is good experimental evidence that carbon monoxide is also responsible for an acceleration of the process of hardening of the arteries. Arteriosclerosis (hardening of the arteries) causes heart attacks when the coronary (heart) arteries become blocked. It causes strokes when the blood vessels of the brain become critically narrowed. It causes gangrene and loss of a foot if the arteries to a leg become blocked. All these conditions occur more frequently in smokers than nonsmokers, and it is likely that carbon monoxide speeds up the deadly process.

Most causes of sudden death result from coronary heart disease. It is thought that individuals who suddenly drop dead develop an abnormal heart rhythm called ventricular fibrillation, in which there is no effective pumping of the blood. Recently it has been shown that individuals who experience occasional extra or skipped heartbeats are more likely to die suddenly than those whose hearts are steady and regular with never a skipped beat. Smoking doesn't seem to cause these premature heartbeats, but if an individual has them, cigarette smoking greatly increases his risk of developing ventricular fibrillation, and sudden death can result.

Smoking and cancer

Smokers and nonsmokers alike know that cigarette smoking causes lung cancer, but for too long this has been thought to be a disease that afflicts men only. Recently death rates from lung cancer in men have leveled off, however, and have actually declined in some age categories where there has been a decrease in cigarette smoking, but the picture for women is rapidly getting worse. In 1960, for every woman that died of lung cancer, there were seven deaths among men. In 1976, the ratio was four lung-cancer deaths in males for one in females.

Lung cancer is the most rapidly increasing cancer in women, killing more than cancer of the cervix or uterus. If present trends continue, within a few years lung cancer will be second only to breast cancer as a cause of death in women—and all because they are finally accumulating a smoking record similar to men. It is not uncommon to find women who have smoked one or two packs per day for thirty or forty years. It is becoming obvious that women who smoke as much as men do die as often as men do.

Some of the early research also demonstrated a relationship between cigarette smoking and cancer of the urinary bladder and of the pancreas. Since these organs are not directly exposed to cigarette smoke, it was thought that perhaps this observation was not significant. Such is not the case. Every major study has continued to show a relationship be tween smoking and these diseases. This year there will be more than 20,000 deaths from cancer of the pancreas. In 1920 the death rate from this disease was three per 100,000. Now it is nine per 100,000. A two-pack-a-day smoker is five times as likely to develop this cancer as is a nonsmoker. Only one person in twenty with this cancer lives five years. There is no doubt that cigarette smoking is a significant cause of this disease.

Cancer of the urinary bladder causes only about 3,000 deaths a year, but perhaps 35 to 40 percent of these deaths are caused by cigarette smoking. A toxic chemical, betanapthylamine, known to cause bladder cancer, is found in cigarette smoke. It may well be the causative agent in the bladder cancer of cigarette smokers.

Another family of chemicals called N-nitrosamines have been identified in cigarette smoke. These compounds are potent cancer-causing chemicals that induce malignant tumors in almost every animal and nearly every organ system in which they are tested. It is not known for sure whether they cause cancer in man, since great care is taken in controlling human exposure to these compounds, but it is likely that they contribute their share to the malignancies that are developed as a con sequence of cigarette smoking.

Smoking and chronic lung disease

The crippling lung disease, emphysema, kills about 35,000 Americans each year. Often death comes after ten or fifteen years of disability and continuous shortness of breath. The smoker rarely quits smoking before he has to fight for every breath. As a result, the disease is arrested in an advanced and crippling stage. Those in such an advanced stage of this disease are often hospitalized several times a year. Even a minor cold can be a life-threatening experience.

Autopsy studies suggest that virtually all smokers develop emphysema to some degree, and that many have lost 30, 40, or even 50 percent of their lungs without feeling ill. Only when 70 to 80 percent of the lung surface area has been destroyed does a sedentary smoker develop symptoms. More than one million Americans are collecting their Social Security benefits prematurely be cause they are totally disabled with emphysema.

It is not known which chemicals in cigarette smoke are responsible for emphysema. Probably several mechanisms are at work to produce this disease. It is known, however, that nitrogen dioxide in low doses will produce emphysema in experimental animals. Nitrogen dioxide is found in cigarette smoke, and it is probably one of the agents responsible for the development of emphysema.

Changes in the cigarette

The past few years have seen real changes in the cigarette itself. The average tar and nicotine contents of cigarettes today are less than half what they were in the 1950's. Be cause of Federal crop subsidies, it is no longer advantageous to leave the tobacco plant in the ground, waiting for the highest price. Plants are harvested as soon as they reach a mature size; consequently the nicotine content of the leaves is less than if the plants were harvested later.

Nicotine content of tobacco leaves can also be regulated to some extent by the development of new strains of tobacco. Special varieties of tobacco are used in those cigarettes that have the lowest tar and nicotine levels. Within the past five years, the tobacco industry has developed a process that "puffs" tobacco in much the same way one might puff rice or wheat. Tobacco treated in this manner is very light and burns rapidly. Cigarettes that are made of "puffed" tobacco have low tar and nicotine contents be cause there is less tobacco in the cigarette to start with. The smoker gets only seven to eight puffs per cigarette of this kind, instead of the usual ten puffs per regular cigarette.

Some cigarette manufacturers have stretched the length of their king-sized cigarettes from 100 millimeters to 120 millimeters. These new longer cigarettes contain no more tobacco than regular cigarettes, because Federal law states that 1,000 cigarettes cannot weigh more than three pounds. Twenty cigarettes cannot weigh more than one ounce, no matter how long or short they are, without the Federal cigarette tax on them being doubled. As a consequence, no cigarette on the market today weighs more than 1.361 grams.

The fact that significant reductions have occurred in the tar and nicotine contents of cigarette smoke without a dramatic increase in cigarette consumption indicates that public taste can be changed. Several proposals have been introduced in Congress that would legislate the maximum allowable levels of tar and nicotine in cigarettes. These maximum levels could be periodically adjusted downward, until eventually cigarette smoke would contain little more than hot air!

Some are philosophically opposed to such legislation, arguing that the only safe way to deal with cigarettes is to quit smoking altogether. This may be true, but it is unreasonable to expect that all smokers will quit. In order to protect the public health, the Government has an obligation to reduce the hazards associated with cigarette smoking as much as possible for those who continue to choose to smoke. Unfortunately, legislation of this type has never made it to the floor of Congress, but has bogged down in subcommittees, where the tobacco industry has lobbied strongly against such legislation.

It may be stated truthfully that cigarette smoking causes more deaths in the United States each year than any other single agent. Alcohol is more widely used, but cigarettes probably kill three to four times as many people as does alcohol. Drug abuse and addiction are always concerns of the public, but more young people will die of the cigarette habit they develop in high school than will die from drugs. Millions are spent to clean up auto mobile exhaust and industrial air pollution, but at the present time cigarette smoking causes three to five times more deaths than does air pollution. There are many reasons why national priorities put the war against smoking on the back burner, but the fact remains that no one thing would prolong life expectancy more than if every smoker would stop smoking!