Vice Nation: Smoking II – The Risks

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You probably already know this stuff, but it has to be covered. Who says bloggers don’t do public service broadcasting?

Nicotine Addiction

This is what gets the dominoes falling.Nicotine is a stimulant drug which causes adrenaline to be released, increasing mental sharpness and feelings of calmness or being in control. It also has a mild pain-relieving effect and releases pleasure/reward neurotransmitters like dopamine and serotonin in the brain.As a result, nicotine is incredibly addictive – to the point only cocaine and heroin are more addictive – and a tolerance can be built up to it really quickly.

By itself, nicotine isn’t that dangerous – that’s why it’s safe to use things like nicotine patches to help smokers quit. However, because of the sheer number of dangerous chemicals contained in tobacco and cigarettes – over 4,000, many of them toxic like tar, formaldehyde and carbon monoxide – as a person builds up a tolerance to nicotine, and smokes more cigarettes to compensate, their health will decline and it becomes harder to quit.

The withdrawal affects of nicotine can be very harsh indeed, leading to irritability (you try being around a smoker who’s gone cold turkey, it’s not pleasant), depression, headaches, strong – almost uncontrollable – cravings and weight gain (smokers who quit often look for something else to put in their mouths).

Smoking is arguably the worst method of drug delivery – worse than injecting heroin, even – because it completely overrides a person’s sense of weighing up the danger vs the experience of a instant hit.

Smoking & Cancer

The chances of a smoker dying from cancer are between 1 in 10 for women and 1 in 5 for men.Nicotine itself isn’t carcinogenic (cancer-causing chemical), though some people might think it’s the nicotine that kills you because it’s the chemical often mentioned when discussing smoking. It does in it’s own way, as I mentioned earlier.

Studies have found up to 20 different cancer-causing chemicals in tobacco smoke. There are also radioactive chemicals, like polonium 210, which in themselves can cause cancer.

There’s absolutely no point listing every part of the body that’s linked to cancer caused by smoking or other forms of tobacco. The short list is: lung, throat/larynx, oral cancers (pharynx, tongue, mouth, nose), brain, leukaemia, cervix, oesophagus, pancreas….

If you chew tobacco (or use things like snus) you’re not safe either. They’re known to contain carcinogenic chemicals like N-nitrosamines and polycyclic hydrocarbons and are linked to higher rates of mouth and throat cancers. Hookahs are considered a safer alternative to cigarettes, but carcinogenic compounds are found there as well.

Chronic Obstructive Pulmonary Disease (COPD)

A family of diseases where the airways within the lungs (bronchioli) are restricted/blocked by inflammation. At one end you have chronic bronchitis which, if left unchecked, eventually develops into emphysema – a condition where the alveoli disintegrate and gaseous exchange (which enables us to breathe) becomes near enough impossible.

Like asthma, the condition isn’t improved through medication but “managed”. Though once it reaches the emphysema stage, quality of life drastically falls to the point where a lung transplant is the only option left.

Heart Disease & Blood Disorders

Nicotine encourages blood vessels to constrict. Usually this only happens when the body is placed under stress, such as strenuous exercise (in non-active parts of the body to ensure more blood gets to muscles) or cold weather (to retain heat).Inducing this constantly day after day with cigarettes will inevitably damage arteries and veins and cause high blood pressure (hypertension), which slowly damages organs.

It gets worse.Smoking causes fatty deposits to build up inside arteries, which over time will restrict blood flow even further and limit the flexibility within arteries that enables them to constrict and dilate – known as hardening of the arteries or atherosclerosis. If this happens in the blood supply to the heart itself, or if some of the deposits get dislodged and travel around the body, it drastically increases the risk of suffering a heart attack or stroke.

Oral Health

I mentioned oral cancers, but according to the British Dental Health Foundation, smoking also causes teeth staining, tooth loss and gum disease. There are toothpastes tailored to frequent smokers but they tend to be more abrasive than regular toothpastes and can, in the long-term, damage tooth enamel leading to increased risk of decay etc.

Needless to say, smoking’s a leading cause of bad breath (halitosis).

Impotence & Infertility

A good blood supply is pretty much essential to male virility for obvious reasons, so the blood supply problems listed earlier will inevitably make the quality of erections poorer. Research has also shown that male smokers have lower sperm counts, lower quality sperm and lower density semen than non-smokers. The good news is that it’s all reversible if men quit smoking.

In women, research on women undergoing fertility treatment has shown smokers have lower chances of a fertilised egg implanting itself in the uterine wall, produce fewer eggs and produce lower concentrations of hormones associated with fertility to the point of triggering early menopause. Again, this damage is reversible if women quit smoking in the 2 years before trying to conceive.

Smoking & Pregnancy

Smoking during pregnancy has been linked as one of the causes of Sudden Infant Death Syndrome (SIDS, also called cot death), can lead to low-birth weight, premature birth and increase the risk of miscarriage. It’s also linked conditions which occur after the baby’s born that will be with them for the rest of their lives like disfigurements, asthma, hyperactivity and learning difficulties.

Even passive smoking is known to affect unborn babies and lead to conditions listed above.

According to an ASH Wales fact sheet from 2014 (pdf), in 2011 33% of Welsh mothers smoked before or during their pregnancy compared to the UK average of 26%. 16% of mothers smoked during their pregnancy alone (12% UK). They tend to come from less-affluent backgrounds.

Passive Smoking

What makes smoking uniquely dangerous amongst drugs (except perhaps other smoked drugs like cannabis) is that is has a direct cumulative negative health impact on everyone in close proximity to the user, even if those people don’t smoke themselves.

According to ASH (pdf), smokers only take in 15% of the smoke produced by a cigarette; the rest is dispersed to the area around them (“sidestream smoke”). This sidestream smoke contains exactly the same dangerous chemicals such as tar, formaldehyde, ammonia, carbon monoxide etc.

It’s fair to say that sidestream smoke will be at a much lower concentration than in a smoker’s lungs because it has room to disperse. However, smoke can cause eye irritation, lung irritation and can trigger asthma in children and adults – even if they’re non-smokers. Over the longer term, it increases the chances of non-smokers developing heart and lung conditions by between 25-35%.

The impact of passive smoking was perhaps first illustrated in the UK by the presenter of BBC’s Record Breakers, Roy Castle, who despite never smoking himself died of lung cancer in 1994. His cancer was linked to his previous job touring jazz clubs – which were about as smoky as it gets – as a musician and long before smoking was banned in such establishments.

This is why there’s no contradiction in being liberal or libertarian and supporting restrictions on public smoking. Once you start to actively erode someone else’s liberty, in this case their right to good health, it’s no longer something that can be 100% permissible, it’s just outright anti-social.

So smoking doesn’t exclusively kill smokers, which leads me nicely into….

How many people die as a result of smoking in Wales?

A key beneficiary of the tobacco industry who aren’t mentioned alongside tobacco companies and retailers are undertakers, who – when you consider the average funeral costs somewhere around £4,000 – must make a considerable amount of money from the premature deaths caused by smoking every year.

According to the 2012 Public Health Wales report (pdf p33), in 2010, 5,450 Welsh residents died of causes which were directly-attributable to smoking. That’s the equivalent of a town the size of Treherbert and just in one year, and that amounts to 18% of all deaths in Wales over the same period.

3,350 of them were men, and 2,100 were women. The leading cause amongst men was cancer (36% of all male cancers were attributable to smoking), and amongst women it was respiratory disease (29.2% of all lung diseases).

Although smoking-related deaths were still higher in the most deprived areas, the distribution is relatively even in all but the least deprived areas (which have lower smoking rates anyway) – particularly amongst men. Wealth doesn’t protect you. The Queen’s father, King George VI, died of a blood clot and, months before he died, underwent surgery for lung cancer which was certainly a result of heavy smoking.

There are, of course, numerous non-health related risks associated with smoking, particularly fires. Both the 1985 Bradford stadium fire and 1987 Kings Cross fire – which killed a combined 87 people and injured a combined 365 – were linked to discarded cigarettes.

I’ve seen first hand the damage smoking does, and I’m sure some of the people reading this have too.

Although it wasn’t the direct cause of my mother’s death, it certainly played a part because of the long-term impact smoking had on her heart and lungs. COPD is listed on her death certificate as a secondary cause and she used to use a pump that looked like a blunderbuss. She started smoking as a teenager and despite attempts to cut down or give up she never quite managed it. If she had properly functioning lungs and a stronger circulatory system, she might’ve stood more of a chance when she fell ill, and that goes for countless other people.

How much does smoking cost the Welsh NHS?

There’ve been various figures produced, but the latest figures I could find from 2013 (pdf) put the figure for treating smoking-related illnesses at £302million a year. According to a 2009 report (pdf), the vast bulk of that – 67% – is spent on hospital treatment, and it was said smoking accounted for 22% of all adult hospital admission costs.

Now, when you look at the figures I gave for the amount raised in Wales via tobacco duty (Part I), it’s clear smoking costs less to treat than it raises in taxes (£421million). This doesn’t include any business taxes and VAT raised by the tobacco companies.

However, you’ve got to add the economic costs – the cost of lost production through smoking-related illnesses/sick absence, the lack of production from those who are trying to quit, the cost of smoking breaks, cleaning up smoking-related litters.

Once these costs are added, the bill rises to £790.6million, which is probably more than alcohol, where I estimated the equivalent figure to be around £690million (Alcohol II– Costs & Benefits).

Part III takes a closer look at one of the most controversial recent trends in nicotine delivery – e-cigarettes/vaping.