Thanks for the detailed answer!
So you must be a bright guy!
Certainly - there are some paradox potential health benefits associated with smoking. See below (you mentioned most of them).
But what is with the majority of health risk associated with smoking? How do you evaluate them?
Cheers
Alex
Health benefits of smokingStudies suggest that smoking decreases appetite, but did not conclude that overweight people should smoke or that their health would improve by smoking.[47][48]
Several types of "Smoker’s Paradoxes",[49] (cases where smoking appears to have specific beneficial effects), have been observed; often the actual mechanism remains undetermined. Risk of ulcerative colitis has been frequently shown to be reduced by smokers on a dose-dependent basis; the effect is eliminated if the individual stops smoking.[50][51] Smoking appears to interfere with development of Kaposi's sarcoma,[52] breast cancer among women carrying the very high risk BRCA gene,[53] preeclampsia,[54] and atopic disorders such as allergic asthma.[55] A plausible mechanism of action in these cases may be the nicotine in tobacco smoke acting as an anti-inflammatory agent and interfering with the disease process.[56]
Evidence suggests that non-smokers are up to twice as likely as smokers to develop Parkinson's disease or Alzheimer's disease.[57] A plausible explanation for these cases may be the effect of nicotine, a cholinergic stimulant, decreasing the levels of acetylcholine in the smoker's brain; Parkinson's disease occurs when the effect of dopamine is less than that of acetylcholine. In addition, nicotine stimulates the mesolimbic dopamine pathway (as do other drugs of abuse), causing an effective increase in dopamine levels. Opponents counter by noting that consumption of pure nicotine may be as beneficial as smoking without the risks associated with smoking.
It has been hypothesized that schizophrenics smoke for self-medication.[58] Considering the high rates of physical sickness and deaths[59][60] among persons suffering from schizophrenia, one of smoking's short term benefits is its temporary effect to improve alertness and cognitive functioning in that disease.[61] It has been postulated that the mechanism of this effect is that schizophrenics have a disturbance of nicotinic receptor functioning.[62] Rates of smoking have been found to be much higher in schizophrenics.[63]
Establishing a link between smoking and health effects
As the use of tobacco became popular in Europe, a number of people became concerned about its negative effects. One of the first was King James I of Great Britain. In his 1604 treatise, A Counterblaste to Tobacco, King James observed that smoking was:
A custome lothsome to the eye, hatefull to the Nose, harmfull to the braine, dangerous to the Lungs, and in the blacke stinking fume thereof, nearest resembling the horrible Stigian smoke of the pit that is bottomelesse.
The late-19th century invention of automated cigarette-making machinery in the American South made possible mass production of cigarettes at low cost, and cigarettes became elegant and fashionable among society men as the Victorian era gave way to the Edwardian. In 1912, American Dr. Isaac Adler was the first to strongly suggest that lung cancer is related to smoking.[7] In 1929, Fritz Lickint of Dresden, Germany, published a formal statistical evidence of a lung cancer–tobacco link, based on a study showing that lung cancer sufferers were likely to be smokers.[8] Lickint also argued that tobacco use was the best way to explain the fact that lung cancer struck men four or five times more often than women (since women smoked much less).[8]
Prior to World War I, lung cancer was considered to be a rare disease, which most physicians would never see during their career.[9][10] With the postwar rise in popularity of cigarette smoking, however, came a virtual epidemic of lung cancer.
In 1950, Richard Doll published research in the British Medical Journal showing a close link between smoking and lung cancer.[11] Four years later, in 1954 the British Doctors Study, a study of some 40 thousand doctors over 20 years, confirmed the suggestion, based on which the government issued advice that smoking and lung cancer rates were related.[12] The British Doctors Study lasted till 2001, with result published every ten years and final results published in 2004 by Doll and Richard Peto. [13] Much early research was also done by Dr. Ochsner. Reader's Digest magazine for many years published frequent anti-smoking articles. In 1964 the United States Surgeon General's Report on Smoking and Health (referenced below), led millions of American smokers to quit, the banning of certain advertising, and the requirement of warning labels on tobacco products.
Health risks of smokingThe main health risks in tobacco pertain to diseases of the cardiovascular system, in particular myocardial infarction (heart attack), cardiovascular disease, diseases of the respiratory tract such as Chronic Obstructive Pulmonary Disease (COPD), asthma,[14] emphysema, and cancer, particularly lung cancer and cancers of the larynx and tongue.
A person's increased risk of contracting disease is directly proportional to the length of time that a person continues to smoke as well as the amount smoked. However, if someone stops smoking, then these chances gradually decrease as the damage to their body is repaired. A year after quitting, the risk of contracting heart disease is half that of a continuing smoker.[15] The health risks of smoking are not uniform across all smokers. Risks vary according to amount of tobacco smoked, with those who smoke more at greater risk. Light smoking is still a health risk. Likewise, smoking "light" cigarettes does not reduce the risks.
The data regarding smoking to date focuses primarily on cigarette smoking, which increases mortality rates by 40% in those who smoke less than 10 cigarettes a day, by 70% in those who smoke 10–19 a day, by 90% in those who smoke 20–39 a day, and by 120% in those smoking two packs a day or more.[16] Pipe smoking has also been researched and found to increase the risk of various cancers by 33%.[17]
Some studies suggest that hookah smoking is considered to be safer than other forms of smoking. However, water is not effective for removing all relevant toxins, e.g. the carcinogenic aromatic hydrocarbons are not water-soluble. Several negative health effects are linked to hookah smoking and studies indicate that it is likely to be more harmful than cigarettes, due in part to the volume of smoke inhaled.[18][19] In addition to the cancer risk, there is some risk of infectious disease resulting from pipe sharing, and other risks associated with the common addition of other psychoactive drugs to the tobacco.[20]
Diseases caused by tobacco smoking are significant hazards to public health. According to the Canadian Lung Association, tobacco kills between 40,000–45,000 Canadians per year, more than the total number of deaths from AIDS, traffic accidents, suicide, murder, fires and accidental poisoning.[21][22] The United States Centers for Disease Control and Prevention describes tobacco use as "the single most important preventable risk to human health in developed countries and an important cause of premature death worldwide."
Carcinogenicity
The incidence of lung cancer is highly correlated with smoking.
An extremely carcinogenic (cancer-causing) metabolite of benzopyrene, a polynuclear aromatic hydrocarbon, produced by burning tobacco.
Smoke, or any partially burnt organic matter, is carcinogenic (cancer-causing). The damage a continuing smoker does to their lungs can take up to 20 years before its physical manifestation in lung cancer. Women began smoking later than men, so the rise in death rate amongst women did not appear until later. The male lung cancer death rate decreased in 1975 — roughly 20 years after the fall in cigarette consumption in men. A fall in consumption in women also began in 1975 but by 1991 had not manifested in a decrease in lung cancer related mortalities amongst women.[23]
Smoke contains several carcinogenic pyrolysis products that bind to DNA and cause genetic mutations. Particularly potent carcinogens are polynuclear aromatic hydrocarbons (PAH), which are toxicated to mutagenic epoxides. The first PAH to be identified as a carcinogen in tobacco smoke was benzopyrene, which has been shown to toxicate into an epoxide that irreversibly attaches to a cell's nuclear DNA, which may either kill the cell or cause a genetic mutation. If the mutation inhibits programmed cell death, the cell can survive to become a cancer cell. Similarly, acrolein, which is abundant in tobacco smoke, also irreversibly binds to DNA, causes mutations and thus also cancer. However, it needs no activation to become carcinogenic.[24]
The carcinogenity of tobacco smoke is not explained by nicotine per se, which is not carcinogenic or mutagenic. However, it inhibits apoptosis, therefore accelerating existing cancers.[25] Also, NNK, a nicotine derivative converted from nicotine, can be carcinogenic.
To reduce cancer risk[citation needed] but to deliver nicotine, there are tobacco products where the tobacco is not pyrolysed, but the nicotine is vaporized with solvent such as glycerol[citation needed]. However, such products have not become popular.
Lung dysfunction
Chronic obstructive pulmonary disease (COPD) caused by smoking, known as tobacco disease, is a permanent, incurable reduction of pulmonary capacity characterized by shortness of breath, wheezing, persistent cough with sputum, and damage to the lungs, including emphysema and chronic bronchitis[26].
Effects on the heart
Smoking contributes to the risk of developing heart disease. All smoke contains very fine particulates that are able to penetrate the alveolar wall into the blood and exert their effects on the heart in a short time.
Inhalation of tobacco smoke causes several immediate responses within the heart and blood vessels. Within one minute the heart rate begins to rise, increasing by as much as 30 percent during the first 10 minutes of smoking. Carbon monoxide in tobacco smoke exerts its negative effects by reducing the blood’s ability to carry oxygen.[27]
Smoking tends to increase blood cholesterol levels. Furthermore, the ratio of high-density lipoprotein (the “good” cholesterol) to low-density lipoprotein (the “bad” cholesterol) tends to be lower in smokers compared to non-smokers. Smoking also raises the levels of fibrinogen and increases platelet production (both involved in blood clotting) which makes the blood viscous. Carbon monoxide binds to haemoglobin (the oxygen-carrying component in red blood cells), resulting in a much stabler complex than haemoglobin bound with oxygen or carbon dioxide -- the result is permanent loss of blood cell functionality. Blood cells are naturally recycled after a certain period of time, allowing for the creation of new, functional erythrocytes. However, if carbon monoxide exposure reaches a certain point before they can be recycled, hypoxia (and later death) occurs. All these factors make smokers more at risk of developing various forms of arteriosclerosis. As the arteriosclerosis progresses, blood flows less easily through rigid and narrowed blood vessels, making the blood more likely to form a thrombosis (clot). Sudden blockage of a blood vessel may lead to an infarction (e.g. stroke). However, it is also worth noting that the effects of smoking on the heart may be more subtle. These conditions may develop gradually given the smoking-healing cycle (the human body heals itself between periods of smoking), and therefore a smoker may develop less significant disorders such as worsening or maintenance of unpleasant dermatological conditions, e.g. eczema, due to reduced blood supply. Smoking also increases blood pressure and weakens blood vessels.[28]
After a ban on smoking in all enclosed public places was introduced in Scotland in March 2006, there was a 17 percent reduction in hospital admissions for acute coronary syndrome. 67% of the decrease occurred in non-smokers.[29]
49 ^ Cohen, David J; Michel Doucet, Donald E. Cutlip, Kalon K.L. Ho, Jeffrey J. Popma, Richard E. Kuntz (2001). "Impact of Smoking on Clinical and Angiographic Restenosis After Percutaneous Coronary Intervention". Circulation 104: 773. doi:10.1161/hc3201.094225. PMID 11502701.
50^ Longmore, M., Wilkinson, I., Torok, E. Oxford Handbook of Clinical Medicine (Fifth Edition) p. 232
51^ Green JT, Richardson C, Marshall RW, Rhodes J, McKirdy HC, Thomas GA, Williams GT (2000-11). "Nitric oxide mediates a therapeutic effect of nicotine in ulcerative colitis". Aliment Pharmacol Ther 14 (11): 1429–1434. doi:10.1046/j.1365-2036.2000.00847.x. PMID 11069313.
52 ^ "Smoking Cuts Risk of Rare Cancer" (in English), UPI (2001-03-29).
53^ Recer Paul (May 19, 1998). "Cigarettes May Have an Up Side", AP. Retrieved on 2006-11-06.
54 ^ Lain Kristine Y, Powers Robert W, Krohn Marijane A, Ness Roberta B, Crombleholme William R, Roberts James M (November 1991). "Urinary cotinine concentration confirms the reduced risk of preeclampsia with tobacco exposure". American Journal of Obstetrics and Gynecology 181 (5): 908–914. PMID 11422156.
55 of the epidemiological studies". Behav Brain Res 113 (1–2): 117–120. doi:10.1016/S0166-4328(00)00206-0. PMID 10942038.
56^ Kumari, Veena; Peggy Postma (2006). "Nicotine use in schizophrenia: The self medication hypotheses". Neuroscience & Biobehavioral Reviews 29 (6): 1021–1034. doi:10.1016/j.neubiorev.2005.02.006.
57^ Seeman MV (2007 January). "An outcome measure in schizophrenia: mortality.". Can J Psychiatry. 52 (1): 55–60. PMID 17444079.
58^ Auquier P, Lancon C, Rouillon F, Lader M, Holmes C (2006 December). "Mortality in schizophrenia.". Pharmacoepidemiol Drug Saf 15 (12): 873–879. doi:10.1002/pds.1325. PMID 17058327.
59^ Compton, Michael T (2005). "Cigarette Smoking in Individuals with Schizophrenia". Medscape Psychiatry & Mental Health 10 (2).
60 ^ Ripoll N, Bronnec M, Bourin M (2004). "Nicotinic Receptors and Schizophrenia". Curr Med Res Opin 20 (7): 1057–1074. doi:10.1185/030079904125004060.
61^ Kelly Ciara, McCreadie Robin (2000). "Cigarette smoking and schizophrenia". Advances in Psychiatric Treatment 6 (5): 327–331. doi:10.1192/apt.6.5.327.
Hi nightlight, may I ask what you are doing for living - what is your job?
I work presently as a 'chief scientist' and CTO in a software company, telecommuting to work i.e. sitting all day in my study (in peaceful Lexington, MA) in front of 7 computers (multiplexed to 5 monitors) and 4 line phone (plus several iPhones & iPod touches for the latest project), puffing away, sipping coffe, nibbling walnuts... Bookshelves cover all walls and the center of the large room, about 10K+ books (mostly physics, chemistry, math, programming, chess, and few in philosophy, psychology; about 3/4 in English, 1/4 in Russian). The work part is programming (C/C++, Java, Javascript, lately Objective C), directing several other programmers (via phones & remote desktops), architecting software for the whole group, researching and developing new algorithms for compression & audio/video coding (have few patents & papers in the field of fundamental compression algorithms, coding and modeling, combinatorics). By education I am theoretical physicist (quantum field theory, foundations of quantum theory), although I left academia right after the grad school (Brown U.), when my interest in computer programming and algorithms took over. The interest in medicine and biochemistry comes from growing up with both parents medical doctors and spending lots of time during my teens in their medical library. I also play chess, mostly against computers although I do have an expert rating from human play (my younger brother is a chess master). So, if anyone is wondering, no relation with tobacco industry, other than as a consumer of their products.