Recommendation to Quit Smoking

To quit smoking or not?

This is a topic that is often discussed, but from a doctor's standpoint, the answer is naturally yes.

Various scientific data have been accumulated, and there is no end to the number of health hazards caused by smoking, while there is not a single piece of data suggesting it is good for health. It truly is a case of "doing a hundred harms and not a single good."

Despite this, why are there still so many smokers who do not quit?

I myself have experience smoking. It was for about four years during my university days, and just before exams, my smoking count would exceed 40 cigarettes a day. I knew that my pharyngitis from colds would worsen every time I smoked, and above all, I knew it was bad for my health. So, during a training camp for the Sailing Team club activities, a classmate and I decided to try quitting smoking together as a vow to win our matches. It was something we started casually, but after the summer camp ended and we spoke at the end of autumn, we asked each other, "Are you still smoke-free?" To our surprise, we both were. With the feeling of "If he's keeping it up, I have to keep it up too!", we made it through the New Year and successfully quit (perhaps this vow worked, as the following year our year won the East Japan Medical Students General Athletic Meet for the first time in the history of the School of Medicine Sailing Team!). I haven't smoked a cigarette since then.

I understand the feeling of wanting to try smoking at some point in one's youth after seeing Humphrey Bogart in "Casablanca" or Jean Gabin smoldering a Gitanes. However, I want people to know that the health damage it causes is significant not only for the smoker but also for those around them. A story I often tell families when I am consulted about quitting smoking is the risk of secondhand smoke. Regarding scientific data on this, a classmate from Keio High School continued research at the National Cancer Center and produced interesting results.

The content showed that as a result of following approximately 30,000 non-smoking wives for 14 years, those with smoking husbands were twice as likely to develop lung adenocarcinoma compared to those with non-smoking husbands.

I remember smiling wryly when I told this story to a lady who accompanied her husband to the smoking cessation clinic, and she turned to him and said, "We've been together all this time, and are you trying to kill me?" Indeed, the sidestream smoke from the burning end of a cigarette is said to contain more harmful substances than the mainstream smoke inhaled by the smoker through a filter. In other words, not just family members, but anyone in the same room as a smoker—regardless of age or gender—suffers some form of adverse effect. Of course, the risk of disease from smoking is not limited to lung cancer; it also increases the risk of various other malignant tumors, heart disease, diabetes, cerebrovascular disease, and respiratory disease. Occasionally, I see elderly people carrying oxygen tanks and breathing through nasal tubes; that condition is also a pathology heavily influenced by smoking.

For these reasons, I strongly recommend quitting smoking, but first, I want you to have a firm will. Beyond that, try visiting a smoking cessation clinic, which is initially covered by insurance, and attempt to quit. In addition to nicotine patches, there are oral medications that prevent irritability while quitting, and many people succeed in quitting using these.

Of course, from my own clinical experience with hundreds of smoking cessation cases, it is said that over 60% of patients complete the clinic program, and around 30% continue to stay smoke-free afterward; treating nicotine addiction is by no means easy. However, recently, some foreign tobacco companies have developed new heat-not-burn cigarettes with the intention of "if quitting is difficult, let's reduce the harmfulness of smoking" (risk reduction). Perhaps due to my experience in smoking cessation treatment, I received various consultations and information from them, and the characteristics are interesting. Based on short-term data so far, it is possible to reduce generated harmful substances by 90-95%, and by not burning the tobacco leaves and paper, sidestream smoke has been eliminated. However, whether the harmful substances reduced to 5-10% will have an adverse effect on the human body (the smoker themselves) requires waiting for long-term results. Nevertheless, the fact that sidestream smoke is zero is a major attraction in terms of reducing the nuisance to surrounding people. The Japanese Circulation Society and the Japan Society for Tobacco Control, which emphasize quitting smoking, have not yet officially recognized these new cigarettes from the perspective that they are different from quitting itself, but in actual clinical settings, opinions are heard that they are better than smoking.

As a cardiovascular specialist, my basic stance is to first recommend quitting smoking. For those who do not succeed, or who succeeded but started smoking again, I would like them to choose this option of risk reduction for the time being, to at least eliminate the negative impact on those around them.

I hope that by the Tokyo Olympics, there will be no one smoking indoors in public places.