If you are stupid, then start smoking.

Not what we have, but what we use;
Not what we see, but what we choose;
These are the things that mar or bless
the sum of human happiness.
-Joseph Fort Newton

Christmas is a time for good news and happiness. It is about love and family and a few days of holidays. We want to forget about the realities of life. It is time to eat, drink and be merry – hopefully within safe limits.

But if you look at the news on a daily basis, there isn’t much to cheer about. Everyday people are getting sick or dying. Sometimes it is our own fault that we get sick. Sometimes we are struck by lightning – so to speak. Just pure bad luck.

One example of self-inflicted illness is caused by smoking. Just a few days ago it was reported that Alberta’s former premier – Ralph Klein – is suffering from emphysema and loss of memory.

The media report says, “Ralph is 68 now and smokes. He’s been smoking since his days as a young teen from a broken home on the mean streets of Tuxedo Park and we’re talking real smoking. As premier, Ralph was going to try and quit on one of those weedless days or weedless weeks proclaimed by the anti-cigarette crowd. It’s years ago now.”

Well, I remember that day when he declared he wanted to quit smoking because I wrote a column about it in January 2004. He said his grandchildren want him to give up the bad habit.

Before that, on August 25, 2003, the Medicine Hat News published a letter I had sent under the heading, “Ten reasons for Klein to butt out.” I had written in response to Klein’s publicised argument that smoking was a lesser evil than drinking. I believe this was after he had stopped drinking.

Now Klein’s advice to the public is, “If you are stupid, then start smoking.”

Klein is a very respected and successful politician. This reputation was achieved because he did what he said he would – in politics. And I thought for the sake of his grandchildren he would quit smoking. But in personal life things are not always that easy.

Nicotine is an addictive drug. It causes dependence and tolerance. Once you are hooked on it, it takes control of your mind and body. There is craving for more and more nicotine.

If you try to deprive your mind and body of nicotine then you get very unpleasant withdrawal symptoms. These are: irritability, anger, impatience, restlessness, difficulty concentrating, insomnia, increased appetite, anxiety and depression.

Smoking is also habit forming. It becomes part of our routine – cigarette on waking up, cigarette after a meal, cigarette with a drink, cigarette with coffee, cigarette before a bowel movement, cigarette after sex (remember Austin Power joke – do you smoke after sex? Get the pun?), cigarette to relieve stress and so on.

One can successfully quit smoking. You need three things: motivation, counseling and nicotine replacement therapy. As a caring society, we can only create awareness and support system to help people quit smoking. But in the end, the success or the failure depends on personal motivation.

Studies have shown that self-motivation, counseling and nicotine replacement therapy achieves the highest rate of success, 40-60 percent in the initial phase and about 30 percent at the end of one year.

Be smart and be healthy. Do not smoke. We wish Mr. Klein good health and happiness.

Merry Christmas to you all.

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Tobacco Dependence Can Be Treated

“The World Health Organization estimates that, around the globe, 1.3 billion smokers purchase 10 million cigarettes every minute, and that every 8 seconds somebody dies from a tobacco-related disease,” Canadian Medical Association Journal (June 15, 2008).

Smoking is the single most preventable cause of death and disability. This has been said over and over again for many years. But smokers continue to smoke and each year we find new generation of smokers take up the habit. They get addicted and dependent on the tobacco to an extent that they find it difficult to give up the habit. In consequence they pay a price in terms of health and suffering. Not to mention the amount of money they spend to buy cigarettes and then to buy medications to treat complications of chronic smoking.

June 15 issue of the Canadian Medical Association Journal (CMAJ) has articles that review the “effective treatment for the ultimate vector of this epidemic: tobacco dependence.”

There are several effective medications available for the treatment of tobacco dependence but the problem is a failure of “dissemination of interventions from clinical trials to the broad population of tobacco users.”

Authors of one article in the CMAJ identified 69 well-designed randomized controlled trials which looked at the effectiveness of medications to help tobacco abstinence at six months and 12 months. The authors observed that varenicline (Champix), bupropion (Zyban) and 4 types of nicotine replacement therapy (nasal spray, patch, gum and tablet) roughly doubled the odds of smoking abstinence compared with placebo.

What about the nicotine inhaler?

Nicotine inhaler appeared to double the odds of abstinence as well, but the results were not statistically significant. Nicotine is also available as lozenges and nicotine sublingual tablets which dissolve under the tongue. Even in the US, 2008 guidelines on this subject agree with the above findings. The authors of the commentary in the CMAJ asks, “So why are we not doing a better job controlling the tobacco epidemic?”

The authors say that the answer is simple. It resides in our inability to disseminate effective interventions from the clinical research setting to the population. The authors give several reasons for this failure. At the physician and clinical level there is a primary emphasis on medically urgent issues, lack of time and support, inadequate training and low self-confidence among providers, and low rates of reimbursement for tobacco-treatment services.

At the population level, the authors say there is a lack of political will to restrict tobacco companies and to promote and disseminate the most effective tobacco control policies (e.g., smoke-free indoor air policies and higher tobacco taxes). Sometimes the politicians give low priority to anti-smoking programs and divert funds to other ventures.

One survey has shown that smokers in general will be receptive to receiving free nicotine replacement therapy and would use it to quit smoking. The question remains, how are we going to make the treatment accessible and affordable so we can prevent death and disability from tobacco-related illnesses? The all powerful multinational tobacco industry will not do it for us. The responsibility is in the hands of the government and the clinicians to target and encourage smokers to seek help. And the smokers should know there is help, if only they would ask.

Remember, every eight seconds somebody dies from a tobacco-related disease.

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Smoke Free Life

Dear Dr. B: I have been a chronic smoker. I have tried to quit but can never succeed. I have given up trying. Is there an easy way to quit smoking?

Answer: Well, you are not alone in this dilemma. It is well known that people give up trying because they find it so difficult to quit smoking. Old habits are hard to break. But with patience, perseverance and under proper guidance they can be broken.

Studies have shown that 70 per cent of smokers now want to quit smoking completely, 46 per cent try to quit each year and more than 70 per cent of smokers visit a health care setting each year. Good news is effective treatments now exist (JAMA, 2000;283:3244-3254).

U.S. Centers for Disease Control and Prevention (http://www.cdc.gov/) says that there are five steps to quitting smoking. These five steps will help you quit and quit for good. You have the best chance of quitting if you use all five steps together:
1.Get Ready.
2.Get Support.
3.Learn new skills and behaviors.
4.Get medication and use it correctly.
5.Be prepared for relapse or difficult situations.

Most smokers fail to quit smoking because they try to quit on their own, without the benefit of highly effective treatments. You need help from yourself (have motivation and get ready), from your family and friends, from your physician (get medications and use it correctly), seek counseling and join a support group (to learn new skills and behaviours and be prepared for relapse or difficult situations).

Physicians have to treat smokers just like they treat patients with chronic diseases such as hypertension, diabetes and high cholesterol levels. After all smoking is a chronic disease.

A minority of smokers (about seven per cent) does achieve permanent abstinence in an initial attempt to quit, but the majority continues to smoke for many years and typically cycle through multiple periods of relapse and remission. So don’t feel bad if you are going through this phase. Don’t give up fighting and seeking more help as success rate can be increased to 15 to 30 per cent if you persevere with the guidelines and recommended treatment.

One way to do it is by enrolling in the Freedom from Smoking Program organized by AADAC and Palliser Health Region, in conjunction with the Students’ Association of the Medicine Hat College.

Gordon Wright, Health Promotion Marketing Coordinator, Palliser Health Region informs me that this is a free program for any smoker who wants to kick the habit. Monday, January 15, 2007 was orientation day. You can phone Rita Aman (Palliser Health) @ 502-8224 or Anne Joly (AADAC) @ 529-3582 to see if there is room to enroll in the program.

Good luck and keep trying. I know you will eventually succeed.

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Second Hand Smoke

Dear Dr. B: I have a friend who smokes outside her house around her two little children. Isn’t it bad to smoke in the presence of children whether it is indoors or outdoors?

Yes, smoking in the presence of children is bad – whether it is indoors or outdoors. A study carried out by Swedish researchers shows children of smokers have nicotine in their bodies, even if their parents smoke outdoors.

The Medical Post reports that the Swedish researchers studied 366 children age two to three years whose parents smoked. The parents of 216 of the children always smoked outside with doors and windows closed.

The researchers found that theses children had twice as much nicotine in their body as children of non-smokers. If both parents smoked indoors, children had 15 times higher levels than children of non-smokers.

Another study has shown that there is a correlation between passive smoking and respiratory illness (cough, wheezing etc.) in children.

Everyone knows the dangers of smoking. If you are a smoker or if you know somebody who smokes then give them the following ten reasons why one should give up on smoking:

1. Albertans smoke more than the national average.

2. In 2000-2001, 683,900 Albertans were smokers.

3. Tobacco causes one in five deaths in Alberta.

4. Tobacco use is the leading cause of preventable illness, disability and death in Alberta and Canada.

5. Tobacco is the cause of an average of 3,400 premature deaths each year in Alberta.

6. Smokers have two to four times the risk of heart attack and sudden death from coronary artery disease than non-smokers.

7. Smoking around children can negatively impact their health.

8. Smoking during pregnancy is associated with low birth weight and health problems in infancy and later on.

9. Exposure to second-hand smoke can increase non-smokers’ likelihood of developing asthma, heart disease and lung cancer and

10. Nicotine is addictive.

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