Questions From A Reader

Today I received the following email:

Thank you for the web site. I have read Smoke Screens – The truth about tobacco and must commend you on a thoroughly researched and well-presented book. I do have a couple of questions that I hope you can perhaps shed some light on if possible. If you take the overall evidence into consideration sighted in your book I suppose these questions do not require answers in the broad sense but your input would be appreciated none the less;

1.       A family friend recently had a minor heart attack and his doctor said that his smoking habit has thickened his blood? Could not find anything specific in this regard in your book.
2.       My brother broke his ankle a few years back and they had to insert a metal pin, the wound would not heal properly and the doctor said it is because of his smoking. I am not a doctor but I am of the opinion that smoking was not the issue but the pin was the cause seeing that as soon as the pin was removed the wound healed. My brother didn’t quit smoking during this period.
3.       Brief mention is made on your blog regarding the administration of anaesthetics and that smokers require different dosages. Is this true?
4.       An interesting example people like to site is that of the Marlboro men and how they died due to “smoking related diseases”. (One was aged 72). Stanton Glantz (he was mentioned in your book) also released a film Death in the West which was originally a television documentary which aired on British television in 1976. If you have any thoughts on this seeming correlation I would like to hear it, perhaps it was due to lifestyle seeing that they were actual cowboys who lived a rugged lifestyle? I would not say that Wikipedia is the most reliable research reference of all-time but here is the link regardless for context. http://en.wikipedia.org/wiki/Marlboro_Man

Sadly, anyone who smokes or knows someone who smokes and has undergone surgery or suffered an ailment is all too aware of the ‘smoking is responsible for everything’ mentality today’s medical establishment espouses. One of my conclusions in Smoke Screens was that what started out as something at least plausible – that inhaling smoke into the lungs could harm the lungs – quickly snowballed into something pretentious and preposterous, as narcissists jumped on the bandwagon to bully people into ‘acceptable’ lifestyle choices. And so we pretty soon were being told smoking is responsible for blindness, acne, impotence, thick blood, cot deaths, and now opportunistic ‘researchers’ wanting their 15 minutes are trying to persuade us that thirdhand smoke not only exists, but is harmful, and that secondhand smoke travels along phone lines and electrical lines to poison our neighbours (if you haven’t read this last link, please do!). I’d say you couldn’t make it up, but they did.

Regarding the questions specifically, while I’m hesitant to say “definitively no” – because I think it’s seldom reasonable to ever be 100% confident – I can be confident in saying it’s unlikely. And unproven. And I’d place a large bet that neither the doctor nor surgeon actually took a blood sample for the specific purpose of testing its thickness (or height, girth, weight or exercise habits) nor what could cause such things. I fall back to the fairly standard line of “if smoking caused it, we’d expect many more smokers to suffer from it.” But the fact is, heart disease is a very complex issue, and one of the points I did make in Chapter 8 is that by picking and choosing which potential factors to look at, researchers are automatically demonstrating a level of bias. More importantly though, that chapter also explained how the smoking/heart studies did not show a link between the two. And that’s for something as broad as heart disease in general – to be so specific as to say the blood is thicker because of smoking specifically sounds like a hugely outlandish lie to me.

I *have* repeatedly seen that smoking does thicken the blood, and various reasons excuses have been given – the toxins are responsible, or smoke increases red blood cell production. I’ve not seen a study or demonstrable evidence of this though. What always amazes me though is how doctors nowadays throw away all other potential factors or an element of doubt as smoking enters the picture. It suggests that smoking is THE definitive cause of anything if the person smoked, and only if they are non-smokers can it be caused by something else (or just bad luck). Heart disease has many potential factors, any of which can be exacerbated by other factors. To say with any degree of certainty that it was one thing is just insane. Especially when no biological mechanism has been found to suggest it – as with lung cancer, we’re still just relying on statistics for a link.

Question 2 – the fact the wound healed after the pin was removed thoroughly lays to waste the claim that smoking prevented it from healing. The ‘smokers heal slower than non-smokers’ is a popular and long-running claim, but somewhere in my book (and unfortunately I forget exactly where) I mention a study that found smokers heal quicker.

Question 3 – it’s certainly true some Marlboro Men have died of ‘smoking related diseases’, and it’s a point that I pondered over for a while. But the truth is, there were many Marlboro Men, and the ones that didn’t die from ‘smoking related diseases’ don’t make the news. What it comes down to is the same as it does for the rest of the population – lots of people smoke, lots of people don’t, and people in both categories will die from ‘smoking related diseases’. It’s also important to remember that the first Marlboro Man campaign began in 1954 – a time where a huge portion of the population smoked, so it’s incredibly unsurprising to find lung disease victims in the smoker category, because there were so many of them. And more recent data show that smokers are the minority in lung cancer cases.

4 thoughts on “Questions From A Reader”

  1. Newly I had an operation at my dentist in my jaw. He told me, it would heal quicker, if I did not smoke. The healing period should be 3-6 months. After 2 1/2 month, the jaw had healed up. I had been smoking as usual. The dentist was surprised. :)

  2. Good questions and good answers Richard! And Marie, I had a similar experience about thirty years ago with a bicycle-accident-broken-jaw!

    I’d add a few thoughts on #s 1 and 2:

    1) I haven’t looked at the studies specifically, but it does seem to be fairly unquestioned in the medical literature that primary smoking has an effect on increasing platelet stickiness and blood clotting. How MUCH it increases it is a different question though. If platelet stickiness was the primary factor in 10% of fatal heart attacks, and if direct smoking increased platelet stickiness by 5% then you could (at least sort of) say “smoking caused one-half of one percent of fatal heart attacks.” If both factors were 50% instead, then it might make sense to blame 25% of fatal heart attacks on smoking. In both instances of course we’re talking about an individual occurrence of a heart attack. Say one of those heart attacks blamed on smoking was “prevented” because the individual had given up their evil habit. Fine ‘n dandy, but they might get a simarly fatal heart attack two days later because they ate too large a meal, shoveled the sidewalk, or had far too much fun in a bedtime romp with a comely partner.

    2) The same sort of reasoning applies to the claim in #2. When you smoke you decrease the amount of oxygen in red blood cells because it’s displaced by carbon monoxide. It seems reasonable that such an effect could slow wound healing to some extent. BUT… we’ve also seen arguments out there that some degree of increased carbon monoxide exposure promotes the growth of secondary blood vessels (I don’t know the details on this particular claim but have seen allusions to it that seemed to be medically-based.) If that second factor is true, and if it was helpful in would healing, then it might cancel out the first.

    In BOTH cases, for Q’s 1 and 2, quite aside from whether the basic claims are true, it’s always a matter of degree. And if the degree and/or the amount of smoking in question is small enough, and if the distress or unhappiness caused by not smoking is substantial enough, then it would be quite reasonable for someone to continue to smoke. And also in both cases, whatever degree of effect we’re talking about regarding direct smoking would be vastly reduced when we’re talking about the effects of exposure to ordinary levels of secondary smoke.

    – MJM

  3. I had an implant of a tooth and the same advice that I should stop smoking. Never had any problem with the implant and with in 2 months I had the crown.
    The problem today is that every disease is caused by smoking or by global warming, an other lie.

  4. Hi Rich
    Your correspondent does raise some very good points. I have recently experienced first hand my medical colleagues sprouting these “facts”. I have too been exercised by the possibility that the veracity of these points may be lacking. However I know that my medical colleagues passionately believe them to me immovable facts.
    Specifically on blood thickening, I suspect the belief may stem from the fact that heavy smokers usually get “Secondary Polycythaemia”: that is their red blood cell count and or haemoglobin levels increase to help increase the oxygen carrying capacity of the blood in response to a relative decrease in oxygen saturation of their haemoglobin. This will increase the viscosity of blood, but I do not believe this will occur without the secondary polycythaemia, which does not always occur.
    I am pretty certain that the smoking and delayed healing thing has been exaggerated beyond hope. On the last point I would add that it is NOT possible to say if ANY death has been caused by or contributed to by smoking.
    In my colleagues defence I can only say that I was “brainwashed” at medical school which I attended between 1975 and 1980 as to the harm that smoking did. I am sure that nowadays the brainwashing is of a degree I couldn’t even imagine.

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