Setting an Example: The Trials and Tribulations of Dr. Lung

For those of you who haven’t heard my joke already, I think it would be quite amusing if I chose to become a pulmonologist so that I could introduce myself as “Dr. Lung” (since “lung” is the closest English approximation for my last name). It’s one field that I’m quite interested in, and one that I feel quite passionate about. Accordingly, I find it distressing each time I discover that a colleague or friend of mine smokes tobacco.

I hardly ever say anything, because I don’t wish to be judgmental. There’s no question of intelligence, or even of being informed (of the many adverse health risks directly correlated with tobacco use – drastically increased risk of cardiovascular disease, emphysema and chronic bronchitis aka Chronic Obstructive Pulmonary Disease, lung cancer, asthma, and much more). These are people that I personally like and for whom I have a great deal of respect and admiration. And yet, I find it troubling that I am not sure whether or not to address the issue of tobacco use among fellow medical students and physicians. I do not have the same degree of responsibility (or at least, I do not yet feel that I do) to provide care and advice to my colleagues as I do with my future patients. Furthermore, on a public health scale, my arguments are stunted because most of my colleagues who smoke don’t do so in public but rather only do so in the privacy of their own homes or in public, recreational spaces that allow smoking (and also, where they are unlikely to be wearing their white coats). For this, I am quite grateful, especially since it gives an asthmatic like me the choice to leave when my airways are feeling tight.

I feel much more comfortable, in the context of myself as a physician-in-training, to talk to patients and others who might seek medical advice about smoking with a much more clear cut approach and sterner tone; in these cases, someone is asking me for advice, and I can help inform them or point them to the health care providers who can provide the right advice. However, with colleagues, it’s much harder. While I am an advocate of self-policing and extensive critique of ourselves and our colleagues in the practice of medicine, it is uncertain what approach is best to take with respect to lifestyle choices. People do all sorts of things to themselves that are harmful, and others that are considered harmful but for which the evidence is much less strong in comparison with the plethora of evidence connecting tobacco use (of any type) with disease. In the end, not knowing what to do or what to say, I just feel sad because I see people I care about knowingly bringing harm to themselves.

While I try to maintain a consistent attitude in promoting smoking cessation without calling out my colleagues on their choices, I realize that this attitude cannot effectively address future suffering on the part of people in my field. To me, this poses a serious challenge to preventive medicine and the basic tenets of public health: if we, as physicians, are so willing to acknowledge that we are “just human,” how can we ever hope that other people will ignore our example and take active measures to maintain their health in every way we can imagine for them?

Because I’m always happy to review:
Smoking: the leading preventable cause of death in the world, with approximately 5 million directly-linked deaths per year (i.e. respiratory diseases such as COPD and lung cancer), and contributing to countless more given the greatly increased risk for cardiovascular disease (ischemic heart disease, or myocardial infarctions/heart attacks, is the number 1 killer and cerebrovascular disease, or stroke, is the number 3 killer). (according to the World Health Organization)
– Smoking causes 90% of lung cancers, and lung cancer is the leading form of cancer death for both men and women in the United States. Smoking accounts for approximately 30% of all cancer deaths in the U.S. (as it also causes other cancers besides lung cancer).
– Smoking is the cause of 90% of COPD cases.
– Smoking increases the risk for developing coronary artery disease by 2-4 times, and doubles the risk of stroke.

From a study in the Annals of Internal Medicine:

Smokers were much more likely to die between the ages of 40 and 70 than nonsmokers. Just 9% of women who had never smoked died during that period of life, compared to 26% of women who smoked 20 or more cigarettes per day (heavy smokers). The difference was even greater for men: 14% of those who never smoked died in middle age, compared to 41% of the heavy smokers.

The more people smoked, the more likely they were to die in middle age. There were no significant differences in lung cancer deaths, or deaths from other smoking-related cancers, in men and women who smoked.

There was one piece of good news from the study. Quitting at any age lowered the risk of dying — but those who quit in their 40s fared better than those who waited until their 50s or 60s to kick the habit.

The CDC conducted a study between 1995 and 1999 that indicated that adult male smokers lost an average of 13.2 years of life and adult female smokers lost and average of 14.5 years of life due to smoking

Finally, as a final note, smoking’s many adverse effects accounts for 1 in every 5 deaths in the United States each year (approximately 438,000). “More deaths are caused each year by tobacco use than by all deaths from human immunodeficiency virus (HIV), illegal drug use, alcohol use, motor vehicle injuries, suicides, and murders combined.” Ironically, this correlates with the statistic that approximately 1 in 5 (20%) of Americans smoke.

End Note: Although it sometimes may not seem so, particularly with my predilection for critical analysis, I’m not a judgmental person. And certainly, I don’t believe that lifestyle choices and behaviors are signs of flawed character. Nonetheless, I do wish that I could find reason to speak, and that others would find reason to listen.

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