When I became a Cardiology Fellow in 1976 I stopped smoking tobacco. Like most bad habits, I never should have started smoking in the first place.
The first time I ever smoked was in the woods with my kleptomaniac high school friend Timmy who swiped a pack from a stationery store along with some chewing gum that was designed to hide the smell from our parents. Lucky for us our parents smoked too, so we got away with it. However, the effects on my lungs and my body were horrible, making me feel sick for days. One might then ask: “So why did you ever try it again?”
But like any intoxicating habit when I went to Duke I picked up the habit for real by hard-core smoking unfiltered cigarettes for about three years. Thinking it to be a rationalized lesser of two evils, I then started using a pipe. Interestingly enough, aromatic pipe tobacco was more highly addictive than regular cigarette tobacco. Because of its more flavorful taste, the chemical enhancers made it extremely difficult to quit. I told people I didn’t really want to smoke tobacco, only doing it to keep my lungs in shape for marijuana. Ha, ha.
Then when I finally went to medical school and later became a Cardiology Fellow in 1976, I stopped smoking for good.
The epiphany for smoking cessation should have occurred in Medical School six years earlier. In a Surgery rotation I stood on my feet for an eight-hour operation while half of a smoker’s jaw was removed for tongue cancer only to then discover that tumor cells still lurked in the surgical margin. However, I needed the reinforcement later by going into a Catheterization Lab day after day for two years only to see one rotten coronary artery after the next.
I also stopped smoking pot at or about the same time because it stopped being enjoyable and because I did not care for its harsh effects on my respiratory system. One joint could make me cough for weeks or occasionally precipitate an episode of acute bronchitis that required treatment with antibiotics. Marijuana also made me eat more than usual and caused episodic paranoia while under its influence. On one occasion when I got ‘the munchies’ and drove to a Deli for a snack, I couldn’t even get out of the car because I thought everyone would be able to tell I was stoned and might call the police. Basically it just stopped being fun.
Over a long period of time I then became a lightweight social drinker shifting from beer when I was in my twenties to Vodka as an adult. In fact, I do not think I even drank at all until I was about twenty-six years old. Once again, I probably should have stopped right there when I overdosed on beer and puked all over my parent’s front yard late one Sunday afternoon. That display garnered no sympathy form my father as he made me hose off the mess because it would make a brown patch on his otherwise perfect lawn.
However, being one of those fortunate individuals who can stop after one drink, as opposed to nursing a miserable hangover that would make me basically useless for doing anything constructive, I would rather be able to function at work or better yet, on the first golf tee at 9 a.m. the next day.
There are other reasons.
Having a career in medicine prohibits substance abuse in general; and drinking while being responsible for patient care is not only derelict negligence, but is also a sure way to lose a medical license. Although I came to loath the responsibilities attendant with night call, principally because I had to do so much of it when I went through training and then later on in private practice, I suppose the advantage was that the forced sobriety may have saved my liver from a cirrhotic fate similar to that of Mickey Mantles’.
There is periodically a great national debate about the merits of legalizing certain drugs such as marijuana and heroin. Included in the arguments are that people will use the drugs anyway, so why not be able to control and tax them? The argument also goes that supplying people with standardized doses and clean needles will prevent lethal overdosing, or transmission of disease like HIV and hepatitis. In the case of marijuana, I am sure that a pot smokers dream come true would be to have regular access to a pack of R.J Reynolds quality ensured “Rolled Gold.”
I do not have an opinion on the subject other than to point out the hypocrisies of the debate’s opponents.
Everyone knows about the great failure of prohibition against alcohol. People wanted it anyway and nothing good came out of it, including the fact that bootlegging and clandestine distillation gave organized crime the monetary base it needed to gain what resulted in incredible social and political power. In fact, their power base was actually enhanced to megalithic levels when prohibition was repealed, forcing gangsters toward the importation or the sale of illegal drugs.
The hypocrisy comes with the fact that the United States Government actually sanctions alcohol and tobacco, two of the most dangerously lethal drugs that have ever been produced by mankind, and that these two drugs are the most widely used across the country.
There is even a Federal Agency, the ATF (Alcohol, Tobacco and Firearms) that regulates these “drugs,” and prevents private entrepreneurs from cashing in on the profits; ergo the Whiskey Rebellion of the 1800s or the all out attempt to stop boot legging home distilleries. If people make their own booze and cigarettes; the government is shit out of luck on the tax revenues.
Illegal drug use pales in comparison, which makes the so-called “War on Drugs” a distracting, hypocritical myth. There is no war, because too many people, including politicians get kickbacks to keep it going. The only effective war is the one currently being waged by the Philippine President who is summarily shooting all the drug dealers. The first effective war occurred when Mao Zedong closed down the Opium dens that had been maliciously facilitated by the British Empire’s drug trade that made it wealthy at the expense of the Chinese peasant. Mao knew that nation building was predetermined by getting China off dope.
Statistics vary on use of alcohol and tobacco, but taken together they account for being the most serious two drug problems facing the country. It is probable that two thirds of all adult American use alcohol socially. Approximately 54 million Americans take part in binge drinking, while about 16 million are heavy drinkers.
Alcohol use contributes to: accidents of all sorts, lost productivity, workforce absenteeism, crime, death, damaged health, wasted lives, physical and verbal spousal abuse, broken homes, and generalized human misery.
Drunk drivers kill 40 to 50 thousand people per year whereas in the thirteen or so years we have been fighting in Iraq, our country has lost only a few thousand lives.
In the early 1990s a snapshot of alcohol related costs to society were as follows:
- Health care expenditures: $18.8 billion.
- Premature death: $31.3 billion
- Motor vehicle accidents: $24.7 billion of which $11.1 billion relates to premature mortality.
- Crime: $59.1 billion.
- Social welfare programs: $10.4 billion.
- The total cost for all categories was $148 billion.
In 1995 the total was $166.5 billion with drug abuse related costs coming in at $108.9 billion. I don’t know what it is now, but can only guess it has escalated.
This economic cost is borne by the entire U.S. population, including those who do not drink and includes: State and Federal governments, private insurers, victims, and family members of alcoholics.
Twenty-three percent of Americans or about 51 million people smoke tobacco, which translates to an annual smoker per capita use rate of approximately 2069 cigarettes for each smoker. That translates to about 105 billion cigarettes and does not even account for worldwide tobacco exports, which are enormous.
When tobacco is burned its smoke liberates almost 4000 chemical compounds, which include its addictive component, nicotine. These compounds, including the residual tars are atherogenic, carcinogenic and locally toxic to lung tissues. Passive environmental smoking also puts nonsmokers at risk, while pregnant women who smoke have higher rates of fetal deaths, smaller babies and SIDS.
In 1999, tobacco related illness consumed 6% of the total health care budget or approximately $76 billion.
Tobacco kills more people in the US than alcohol, cocaine, crack heroin, homicide, suicide, motor vehicle accidents, fires and AIDS combined.
At a little over 400,000 deaths per year this is equal to about the number of U.S. lives lost in WW II alone or the U.S. death rate combined for WWI, Korea and Viet Nam.
Smokers miss 2.3 more days of work per year than nonsmokers and smoking reduces life expectancy by about 5 years compared to nonsmokers.
Smoking related illness accounts for 20% of all cardiovascular problems and 30% of all cancer related illnesses.
24 million Americans have the chronic lung disease of COPD or emphysema, while smoking account for 25% of all residential fires.
As an indirect but nevertheless important cost, cigarette butts account for 20% of all carted U.S. trash. Think about how many are not even carted but simply get thrown on the ground.Also think about the fact that they are biologically inert and last for fifty years.
Other drug use statistics include about 14.6 million marijuana users. One third of these are addicts who smoke it 20 or more days a month. Unfortunately, marijuana smoke is equally as lethal as tobacco smoke in its risk to potentially cause COPD, emphysema, or cancer with an as yet undetermined risk of causing atherosclerosis. The problem is that the smoke is not filtered which therefore makes each joint equivalent in toxicity to about three filtered cigarettes. It also causes cognitive dysfunction and lowered IQ scores over time.
Non-medical use of prescription drugs such as narcotics and sedatives include about 6.2 million persons. Interestingly, although narcotics are one of the few addictive substances that someone can use on a daily basis and still function as a useful element in the workforce, they are still highly addictive. Users also develop tolerance, which requires increasingly higher doses to maintain a drug effect, followed by the horrific temporary illness associated with attempted withdrawal.
In 2002, two million Americans used cocaine, 1.2 million used hallucinogens, and 166,000 used heroin.
America’s hypocrisy, and in particular American Governmental hypocrisy, derives from the relative negative importance each category of substance abuse, other than alcohol and tobacco, has on society as a whole. Alcohol and tobacco represent a mountain, while the other categories in comparison represent miniscule anthills.
The fact that two of the worst offenders are either government approved or government sanctioned and that the tobacco industry is actually protected by government subsidies and tariffs makes any propaganda effort supporting a war against drugs laughably ludicrous. The overall adverse impact of drugs other than tobacco and alcohol pales in comparison to the combined poisonous and secondary cost effects of these two products.
If the Federal Government wanted to be even-handed about a drug policy it should ban all drugs. Since it cannot, or will not, as learned by the lessons of alcohol prohibition in 1919, it would be wiser if the government would at least legalize marijuana, require it to be a filtered product and impose similar laws to those related to alcohol when a person drives while impaired.
Alcohol, tobacco, marijuana and other drug use cannot be stopped. Because it cannot be stopped, it should then be regulated and highly taxed. Additionally, tax deductions and tax shelters for tobacco and alcohol companies should be eliminated while advertising their products should be outlawed. It is also time to stop suggesting to our children that there is anything glamorous, seductive or even humorous about using alcohol or tobacco. Alcohol and tobacco are slow poisons. They take a long time to kill you; but unfortunately will never be removed from mainstream culture or subculture.
Marijuana, if unfiltered, has the equivalent lung cancer or COPD risk as cigarettes. It also makes people brain dead zombies and can cause breast development in men because of secondary increased estrogen effects. So what’s wrong with having a society of alcoholic, cigarette and marijuana smoking cirrhotic, lung diseased, brain dead, big boobed zombies?
On the other hand, because Cocaine or stimulants like amphetamine and Ecstasy, or intravenous drugs like heroin are so highly toxic and acutely dangerous, these products should all remain criminally banned. Heroin addicts could be allowed easy access to methadone to get them out of needle parks, but controlling prescription drug abuse is a hopeless cause at best. There are too many well-stocked medicine cabinets in the home, as children take their cues from parents who are overly prone to pill-popping instant cures for whatever ails them physically or emotionally.
Because of the significant health care and other societal costs linked to alcohol and tobacco, the tax base generated on these products as well as on any other potentially legalized drugs could be put into a liability fund created to offset those costs. The tax rate could be based on the number of users factored against the cost to society because God knows that under-funded hospitals could certainly use the cash.
This fund could also include an automatic, immediate reimbursement to any person hurt or maimed in a drug or alcohol related incident and an automatic disbursement to any family or spouse who has had a loved one die in a drug or alcohol related incident. Why should the rest of society suffer because someone else wants to drink or to smoke himself to death? Or worse yet, why should society suffer because someone else wants to drive himself into your car after drinking his judgment into oblivion?
And if society is not willing to execute a drunk driver who kills someone else, which in reality is a form of premeditated homicide, then there should be a heavy price to pay for it otherwise. Life in prison would be an alternative except then we as a society would still have to pay for room and board.
It is not infrequently when I take a medical history and ask people if they drink alcohol that they will answer in complete candor: “No. I only drink beer.”
Many other patients, in reference to smoking, will say that they light them up, but for the most part then only let them burn out.
I take it all with a grain of salt. After all, I think most people know that beer is not really alcohol and that President Clinton did not really inhale pot smoke or have sex “with that woman Monica Lewinsky”, either.
“Doctor. I don’t drink alcohol. I only drink beer. And when I light a cigarette, I just let it burn out in an ashtray”
Oh demon alcohol
Sad memories I cannot recall
Who thought I would say,
Damn it all and blow it all,
Oh demon alcohol
Memories I cannot recall
Who thought I would fall
A slave to demon alcohol
(Ray Davies and the Kinks)
|Statistics on tobacco, drugs and alcohol are derived form data generated by: The CDC, U.S Government Information
|Resources, Goodman and Gillman’s Textbook of Pharmacology, The National Institute on Drug Abuse,
|Dr. Robert Shubinki’s//wolfweb.unr.eduand ‘In Defense of Smokers’ by Dr. Lauren N. Colby, The WHO Tobacco Atlas