Let me start with a disclaimer, I'm not advocating the practice of smoking or using tobacco or nicotine - not in a million years - and I'm not trying to justify a bad habit. In fact, I have my own reasons to want to quit. In the event that tobacco had some unexpected medical property as is sometimes implied by certain research, it very likely still makes a very poor choice of a medication, fair enough?
However, I continue to have some serious concerns about some of the things that are said about tobacco, tobacco use, and tobacco companies, some of the things that are blamed on tobacco, and the way that smokers may be blamed, stigmatized, or perhaps even penalized because of someone's opinions about tobacco. I have seen it suggested in medical journals that smokers should be denied medical coverage because of the "self-inflicted" nature of their medical problems, even when the very same thing can be said about the accidents and injuries of athletes, sportsmen, or outdoorsmen.
I have at least two medical diagnoses associated with smoking - my doctors were eager to blame them on tobacco although the legal status of these diseases is "idiopathic" diseases - diseases of unknown causes. Do doctors have a legal right to place blame on tobacco or anything else, for diseases with this status?
I started out believing that tobacco was to blame for my troubles, because I didn't know what else to think, and I believe it for a long time - but when I tried to learn how tobacco was doing these things so that maybe we could prevent it even for people who couldn't quit, I came up very much empty handed. When I started to look at the research, there's usually not much to support blaming tobacco, and plenty else that might deserve blame, such as infection (which based on the research we have so far can easily be expected to be found in patients with these diagnoses, if anyone bothers to look for it), genetics, or even sometimes occupational hazards.
With one of these diseases, Hidradenitis suppurativa, several authors wanted to rename the disease "Smoker's Boils" to emphasize smoking as a cause, and they were responded to in the medical journals by no less than the man who is probably the leading authority on the disease as the author of dozens of articles and as the editor of most of our medical textbooks on the subject, who reminded them that we just don't have the data to justify blaming tobacco. He also pointed out the existance of the "Smoker's Paradox" which involves a substantial set of diseases where smokers show a decreased disease burden, including acne vulgaris (Hidradenitis has often been thought to be related to acne and has sometimes been called "acne inversa"), and these often seem to involve diseases that feature infections.
With another one of my diagnoses, the very first medical paper I read urged doctors to consider the possible role of infection and to consider using antibiotics before applying severe surgical procedures. While this disease isn't as well researched, possibly in part due to the popular notion of it being self-inflicted, there have been some routine findings of certain infections here too, literature that instructs us to consider them different than the infections they tend to resemble without any justification for considering them separate things, and here once again authors who may be over-zealous in blaming tobacco for the condition.
One researcher was so convinced that tobacco was the cause of this one that he moved to have the diagnostic criteria changed to exclude anyone who didn't smoke, but this is another tobacco-blaming proposal that has never caught on, perhaps again with good reason.
The information about these two diseases even from some of the best sources can be so poor as to be badly misleading, one very popular source actively discourages doctors from assigning a role for infection in Hidradenitis suppurativa. What has always happened with every doctor is that they look at my skin condition and all of them say "You DEFINITELY have an infection" then they look it up and come back in the room thinking it isn't an infection at all because of what they just read, just as I once thought the same thing before I began looking at the research.
Doctors thus misled continue to waste very valuable doctor-patient time when I am with them, lecturing me at length about smoking as if they really think I've never heard such a lecture before. That in itself can be harmful if urgent medical concerns are being excluded from the discussion with the doctor to make room for more lecturing.
Two points in particular seem worth mentioning - one is that history still can't seem to provide us with evidence of either disease existing any earlier than about 1830, hundreds of years after Europeans and colonists were introduced to tobacco; the other is that if there is a statistical connection between these diseases and smoking and it isn't what most people think, then what it is? If there were "Smoker's Paradoxes" at work, could trying to quit actually make any such diseases worse, even if the last thing anyone would blame for that is the effort to quit?
My last two attempts to cut tobacco use by even 50% resulted in my diseases becoming unmanagable to the point of requiring surgery. I have been told before when the very same problem escaped from management, that if the antibiotics didn't work I'd be cut in half to save my life, because at that point the infection was raging so badly that no one could deny if was infection even after the misinformation - that's what I got the last time I tried to cut down and the time before that.
I've tried to make my doctors the deal that if they get the infection out of there that seems to go crazy every time I try to cut back, I will try again to quit, but they have never honored this deal and usually struggle to believe there is infection present even after they themselves declared there was, once a trusted source of theirs talks them out of it.
Even if reducing tobacco use doesn't make someone's condition worse, by the same token promising the patient that the condition will improve if they quit (the obvious opposite of "tobacco caused it") might also fly in the face of the status of these diseases as being of unknown causes. Literature and research may simply not support these claims.
I have to say it has been both tiresome and harmful to have tobacco blamed for these things, and in turn for me to blamed for using it. It can also severely strain relationships with family and loved ones, who don't have the opportunity to dig into the research and see for themselves that maybe you're not bringing things on yourself after all. They tend to believe what they're told, just like I used to. I was shocked to discover that doctors' trusted sources could get things so wrong, but they're only human and they're often spread so thin trying to cover so many diseases that mistakes may almost be inevitable sometimes.
I also have to say that I'm sorry to see the likes of some of the propaganda campaigns against tobacco and must seriously question how much fact is involved - I've been seeing various ads from "truth.com" formerly "truth.org" and the only thing I'm sure of as fact is that smoking can stain your teeth. Some of it sounds absolutely preposterous, such as suggesting that tobacco companies have genetically engineered tobacco to be twice as addictive by doubling the nicotine content.
Do they actually think I would smoke twice as much if someone did that, or is it more realistic that I'd only need to smoke half as much to get my fill, so tobacco would only cost me half as much, and tobacco company profits would be cut in half because of it? Why on earth would any company want to cut their profits in half?
I'm not going to say tobacco might not be bad for you, but if it is so bad, why does anyone need to make things up about it? It's bad enough that it stinks, it's expensive, and it's inconvenient, is it not? Worse yet, it can obviously confuse doctors and no one wants their doctor to be confused.
So if I ever try to quit again, I want to try for the right reasons - that it's baggage that I just don't need, not that it's the cause of all my health problems or that if I give it up I might be magically cured of them, which may be two things that doctors really don't have much business saying no matter how often any of us hear that.
It doesn't help us find the true causes of any disease to latch onto the first thing that's handy and make a scapegoat out of it, and start saying things that we really shouldn't be saying yet.
This even goes for my lung troubles - how could that not be the fault of smoking? Because plenty of people smoke without that happening, and because it can happen even to people who don't smoke. Futhermore, my lung troubles don't follow a slow gradual downward curve as one might expect if smoking were to blame, they follow random stairstep patterns where there is typically loss of lung function associated with community acquired infections, there is generally something going around my wife's office at work when these things happen.
This can happen to people with various lung problems, but when the pattern goes so far back as right before the lung trouble started in the first place, then I have to wonder whether infection could not only be a widely accepted exacerbating factor, but perhaps even a root cause, and one still eligible to be eliminated by careful and thoughtful use of existing antibiotics.
The first complaint of lung trouble I ever had was when something was going around our community that I may never know the name of, I called it the "stop smoking flu" because while lots of people caught it, anyone who smoked including myself said "geez, I gotta quit" - just all of the sudden I went outside in the cold and could barely breathe. (At the same time, one our friends ended up with a collapsed lung due to infection). This was also the first of my bouts with lung trouble linked to infection that actually got better, which I am assured that lung trouble isn't supposed to do.
I cannot help but keep thinking about the subject of reversibility, though - if infections cause symptoms in infected smokers, but can cause the same symptoms even in non-smokers and people with healthy respiratory systems, aren't the same symptoms that are supposed to be irreversible in smokers routinely seen to reverse in any non-smokers who recover from the same infections? Even if this seems fairly obvious or self-explanatory, there may still be room for concern about doctors or other caregivers routinely confusing these two to make smoking the cause of the same symptoms seen in non-smokers.
What if smokers tend to get stuck with symptoms because they tend to get stuck with certain infections for various reasons? - and while smoking is going to get blamed for that as well, my Hidradenitis diagnosis is one where we've seen such a high prevalence of certain gene variations that genetics may play a significant role, and could have patients gravitating toward tobacco to suppress disease symptom to compensate for genetics that may not be as effective at resolving infections without the aid of antibiotics.
Many of the known features of certain lung conditions seem highly suggestive that the immune system may be responding aggressively but appropriately to the presence of infection, and some of the latest medications I'm seeing in advertisements are more that intend to target and suppress immune function in various ways.
Another thing I might mention is that every one of my diagnoses is very strongly suspected by a number of researchers of being an autoimmune disease in nature, and in some of these cases the presence of antibodies that recognize both the host and microbial invaders has been reported. There is a process often called "molecular mimicry" where because of similarities between humans and certain microbes, some antibodies may accidentally target both. This may be something in particular that the physicians I've been to haven't been properly breifed or advised on.
While long-term studies or follow up may be scarce, accounts do exist for a number of both smoking-related diseases, and suspected autoimmune diseases, of the symptoms being resolved through the use of antibiotics. This might not always work, but even the matter of how antibiotics work and therefore how best to use them, is an area of ongoing inquiry, where it might not be wise for anything to think that we have all the answers yet.
So what am I trying to say with all this? Well, how about:
--Try quitting because you want to, not because someone is blaming all your troubles on tobacco or is making you promises about how quitting will likely cure you.
--Be careful, or at least watchful of how medical conditions respond to efforts at cutting back or quitting, and if a condition worsens, don't be afraid to wonder if the attempt at cessation might be making things worse or to discuss it with your doctor.
--If you develop such concerns and are lucky enough to have loved ones who will listen to you, consider sharing your concerns or suspicions with them.
--Be prepared if it helps you to, to remind others including doctors, of the status of your diagnosis as idiopathic, which means "of unknown origin" and not "caused by tobacco" (or other lifestyle factors), or that some of these diseases may remain virtually unheard of in the first several hundred years of tobacco use.
--Be prepared if you are so motivated, to share literature and research with others to help spread knowledge and awareness of not only the association with tobacco, but of the disease themselves and of other possible causes or risk factors for the diseases, such as infections, autoimmune problems, genetics, or anything else.
--Don't beat yourself up if you continue to use, or find it too difficult to quit for now. Maybe you aren't bringing all your troubles on yourself, regardless of what anyone says.
I've posted a few items in various DS forums about these things before, but there is still more out there. (To give a notable example, researchers boasted having resolved another disease often associated with smoking, namely Reynaud's Phenomenon, simply by treating H. pylori infection with antibiotics).
What brings this subject up again for me is several articles I stumbled across yesterday. These links probably won't last forever, but for now
"She’s been on different treatments over the years, but now uses several medications to help control her symptoms, as well as supplemental oxygen when she flies and sleeps. 'Originally, doctors thought I would need a lung transplant because they thought my COPD would get much worse quickly, but it’s been fairly stable,' Chang says. However, she points out, 'every time I get an infection, my condition gets worse.'"
I know the feeling, including that I've been "beating the odds" a bit myself - I'm not supposed to have the hands I'm typing with, according to doctors. How do I blame smoking for the loss of them, when I still have them?
"But by the time he was 49, Rich came down with pneumonia twice in 30 days. 'When I first got sick, I refused to stop doing what I was doing because it was ‘too important,' he says. 'I probably lost about half of my lung capacity in those two episodes.' After that, he was finally diagnosed with chronic obstructive pulmonary disease (COPD), an umbrella term used to describe a group of lung diseases that block airflow and make it hard to breathe.
'From that point on, some type of intervention became necessary for me to be able to continue to breathe,' Rich says. 'But if I had not had pneumonia twice, I probably still would not be diagnosed.'"