FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

TOBACCO's SONG: "How can I hurt you? let me count the ways!"

Question: It seems every time I turn on the TV, I hear newscasters talking about the dangers of tobacco. I know about lung cancer and heart disease. What other risks are associated with tobacco use, and is the problem as bad as portrayed on TV?

Answer: The use of tobacco is indeed a high-risk activity. We know that tobacco is linked to a growing list of health problems. The reason you frequently hear about the health consequences of tobacco use is that each addition to the list is a "newsworthy" story. Also, the magnitude of health problems and subsequent health-care costs to our country from tobacco use make announcements discouraging the use of this dangerous substance worthwhile.

Despite what one of my skeptical friends who smokes says, the anti-smoking campaign by government and media is based on good scientific evidence. It is also legitimate for government to insist on smoke-free workplaces because of the mounting evidence of the dangers of second-hand smoke. The same dangers, of course, exist for your family members in your own home. Here, it's not the government's responsibility to make sure your family is safe from second-hand smoke -- but it is yours. Thirty percent of all cancers are directly linked to tobacco use. In practical terms, this means that if no one used tobacco, the total number of cancers would drop by 30 percent. Also, the risk of certain types of cancer is particularly high for tobacco users. For example, as you alluded to in your question, smoking is strongly correlated with lung cancer. In fact, this habit is responsible for 80 percent of all cases of lung cancer.

The use of tobacco also significantly increases the risk of cancer in the nose and throat area -- including the lips, tongue and larynx -- as well as in the esophagus, pancreas, stomach, kidneys and urinary bladder. It also increases the likelihood of some non-cancerous conditions. Heart disease, as you mentioned, is certainly one of these. Other conditions you may not be aware of include emphysema, osteoporosis, stomach ulcers, stroke, and it can even be responsible for abnormal pap smears. Wow! I sure am glad I quit smoking a long time ago. The exact way in which tobacco, regardless of the form that is used, causes cancer and other associated health problems is not clearly understood. Some evidence suggests that part of the problem is the direct chemical irritation caused by the tars and nicotine in tobacco. Other evidence suggests that the free radicals produced by smoking tobacco may also play a role. Even the constant exposure to the carbon monoxide in tobacco smoke may be a causative factor.

Research is currently in progress at many centers to identify the mechanisms by which tobacco use causes disease. Equally important, medical and social science investigators are also working to identify ways to successfully prevent young people from starting to smoke and to help smokers quit. Tobacco use is, of course, a problem in both urban and rural areas. Most attempts to educate citizens about the risks of using tobacco and the ways to quit have been a one-size-fits-all approach. Here at the Ohio University College of Osteopathic Medicine, our new Center for Appalachian and Rural Health Research is gathering rural-specific data through intensive "grass roots" research. I'm hopeful that this will be a major step forward in developing new programs that will improve the health of our fellow rural citizens across the nation.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.