Even with all the other drama going on the world right now, it is hard to overstate the significance of the tobacco bill that Congress approved Friday. It is probably the biggest thing to happen in the United States this year. It is a bigger story than the potential collapse of the banking industry, just because the personal and financial losses from tobacco use are greater than the combined value of all the banks in the world. It is a bigger story than any war the United States has a hand in — more people die every day from tobacco than from military action. With the Tobacco Control Act, the richest nation in the world has turned the corner on one of the deadliest forces in history.
People don’t fully appreciate the harm that cigarette smoke does because they think of illness and disease as being random events with a single, usually unknown, cause. Yet from my work in pharmaceutical research, where we pore over data on billions of signs, symptoms, and diagnoses of illness and draw connections, it is impossible to avoid the conclusion that most or all diseases have multiple causes. And the largest cause of disease, linked to more than half of all signs, symptoms, and diagnoses in all the data I’ve been able to see, is smoking.
One reason we don’t hear much about this is that public health campaigns have tended to cite the most obvious and troubling diseases linked to smoking, in order to persuade smokers that it is a good idea to stop smoking. I think those campaigns have worked. Lungs, heart, blood vessels — we all know that tobacco smoke rips them apart. People like me can look at health data and draw a direct line between smoking and diseases in those parts of the body. But I’ve also seen connections between smoking and other health conditions that haven’t been so heavily publicized.
Depression. Slow recovery from surgery. Psychosis. Wrinkles. Flu. Memory loss. Itching. Weight gain. Headache. AIDS. Diabetes. Coughing. Joint pain. High cholesterol levels. Cancer. Angry outbursts. Liver failure. Feeling cold. Feeling dizzy. Fatigue. All smoking-related in varying degrees.
And I could go on for pages. The point is, almost no matter what sign, symptom, or diagnosis you might name, most of the occurrences in the data I see are among smokers. Non-smokers make up most of the people in the data, but they don’t have so many diseases or symptoms to report — they don’t get sick all the time the way smokers do.
The connection between smoking and disease is so well known within the pharmaceutical industry that smokers are completely excluded from many drug tests. The smokers’ more frequent illnesses and deaths could make a drug look more dangerous than it is.
Of course, tobacco smoke also causes illness among former smokers and non-smokers. This just means that the harmful effects of tobacco are that much greater than the simple difference in experience between smokers and non-smokers. The link between tobacco and illness is huge. I am not going out on a limb by saying that more than half of all illness is smoking-related.
And so, we could cut back our diseases, our national health care costs, by about half by getting rid of smoking, right? Well, not so fast. Smoking is both an addiction and a cultural phenomenon. As such, it can’t just be whisked away. An individual who wants to quit can do so — though perhaps only after considerable time and effort — but we can’t make that decision as a nation. All we can really do is restrict and discourage smoking and assist those who are ready to quit smoking.
There are those who say that the Tobacco Control Act won’t do much to discourage smoking. If it’s true that people from Philip Morris wrote most of the bill, perhaps they are among the people who think that cigarette smokers won’t be affected by the changes. But anyone who thinks that is mistaken. That is a subject I will turn to next.