Mohamud A Verjee , MBChB
Assistant Professor of Family Medicine
Director of Primary Care and Clinical Skills
Weill Cornell Medical College in Qatar
As the saying goes: you don’t know what you’ve got until it’s gone. And, sadly, this is often the case with health—I’ve seen many patients who assumed their bodies could survive a bad habit only to watch it kill them. One story sticks out in my mind, involving a man I’ll call Khaled.
Years ago, Khaled walked into my office for his first visit. As part of a routine exam, I asked him questions about his lifestyle. He told me he smoked. I urged him to quit, yet over the next 10 years the same conversation took place—I’d ask him questions, he’d make excuses about why he hadn’t quit. I offered assistance in the form of prescriptions, patches and counseling—we frequently discussed the issue of his smoking. Despite these efforts, he continued to smoke and lean on excuses. Then, one day, he came into my office with a persistent cough. He told me he had coughed up blood. A rapid investigation revealed abnormal tissue in his lungs, and it was cancer.
“Doctor, what can we do about this?” Khaled, an emaciated version of the man I once knew, asked me. I didn’t know how to respond, the cancer had already spread into other parts of his body at that point and I knew the odds against his long-term survival. It was summer when he first found out and he talked about surviving through the new year. I knew the odds against that, too. He was dead in the Fall and likely suffered more those last months of his life than all of it combined. It’s impossible for me to describe how relentless cancer is once it starts—how shocking and unstoppable it is. It’s also impossible to calculate the suffering his family experienced.
This story plays out almost every day in Qatar, where the annual smoking rate is 12,000 cigarettes per person, according to a national study. The same study revealed that residents in Qatar purchase at least 1 billion cigarettes per year, totaling more than USD 65 million in sales. Many people in Qatar become seriously and terminally ill as a direct result of this habit. The economic impact of this is proof—USD 150 million is spent per year in Qatar on hospital fees to cover care for patients with smoking related disease.
Is it Really a Choice?
People call smoking a habit, a lifestyle choice, but doctors around the world are now calling it a “disease.” And in Qatar, this disease has become a serious epidemic. Because of the psychological and physical barriers to quitting, regular doctor visits and counseling are necessary to ensure that many patients succeed. And most of the people who quit had to try several times and say it’s the hardest thing they’ve ever done. Why?
The nicotine in cigarettes is highly addictive, and researchers in the tobacco industry figured out about 100 additional, toxic ingredients to make each cigarette even more powerful and addictive—once you smoke just one, your body craves more and thus begins a repetitive act of smoking, a habit.
When an activity like smoking becomes a habit, you don’t have to think, you just do it automatically. And the longer you do it, the harder it is to stop because, without you even knowing or consciously choosing, your entire experience in the world becomes related to it. Moreover, the smokers you associate with are constant advertisements that support your habit. Considering all of this, quitting is a huge life change that not only involves feeling physically ill but also feeling temporarily estranged from life and friends as you knew them.
Many products exist on the market to support the body when you want to quit smoking, and these should only be used under close medical supervision. A practitioner will not only guide you through the physical symptoms of withdrawal—which make up only a small percentage of the battle—but will also recommend counseling.
Because as a smoker, your habit is tied in with everything you do in life, you have to be vigilant at all times about avoiding buying cigarettes, lifting one to your mouth and lighting it. Counseling is now being prescribed more and more so that smokers have support, psychologically—reminders of why they are quitting, how long the awful feelings last. It’s an overwhelming battle but one that results in the chance to live a much longer life, and this has been studied.
Based on data collected in the late 1990s, the U.S. Centers for Disease Control and Prevention (CDC) estimated that adult male smokers lost an average of 13.2 years of life and female smokers lost 14.5 years of life because of smoking. And this does not include data on quality of life—impacts from smoking can make it harder to breathe, get around, work, or play long before you die.
Out of Sight, Out of Mind, Out of Time
Smoking causes heart disease, stroke, lung cancer, bronchitis and emphysema. The habit additionally contributes to high blood pressure, reduced eyesight and cervical cancer. This is all not to mention the yellowing of the teeth and persistent cough. Anyone can observe these problems. However, the biggest ones, the deadly diseases, begin in the smallest parts of the body—the strands of DNA.
Although microscopic, genes and the changes they can cause in cells are powerful enough to cause extreme suffering and death to a human in just a few months. We are at a stage in medical science where we understand this with great certainty. Indeed, every time you inhale cigarette smoke, you expose your cells to it and this, over time, causes the genetic material in cells to change in a generally predictable way.
Researchers in our labs here at WCMC-Q are now looking at what happens to the cells of the lungs as they are exposed to smoke on a regular basis. What they are finding is that certain genes switch on within these cells that are off in non-smokers. So when a smoker comes to visit me in the clinic, we may do all of the scans available to mankind, yet these do not tell the real story of their future health. This is written in their genes, and their genes are affected with each inhale of a cigarette. In essence, smoking is like constructing a bomb inside the body but not knowing when the timer will go off.
Popular opinion dictates that once a smoker quits smoking, their body will go back to normal in a few years depending on how long they smoked. In part, this is true—cells in the airway will come back into action causing a cough that will clear everything out of the lungs over time. And with some tooth whitener, it will seem as if a person never had a cigarette. However, it should be taken into consideration that any genetic damage done while smoking, won’t be obvious in diseased or healed form. It’s better not to smoke at all.
A common pastime here in Qatar, shisha smoking is actually more dangerous than cigarette smoke—some studies show it to be several hundred times more dangerous. While cigarettes have filters to moderate the smoke, shisha smoke passes directly into the mouth, throat and lungs.
Shisha smoking is particularly engrained in society here because it’s so socially accepted and encouraged. Indeed, this activity is at the center of many gatherings in Doha. Walk through Souq Waqif and you will smell the lingering aroma of apple shisha—and that alone is an intoxicating draw.
However, I must encourage everyone to rethink this activity as another cause for smoking-related diseases that have reached epidemic proportions here in Qatar.
Khaled’s story is not unusual here in Qatar. In fact the per capita consumption of cigarettes here is more than that in Europe, a renowned hub of smoking. What drives this is the low cost of cigarettes—the easy, seemingly consequence-free purchase of them. Yet the price in riyals is an illusion—the true price, the only real price must be calculated in years lost with a spouse, children, grandchildren and friends.
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The medical information in this article is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be patient education, does not create any patient-physician relationship, and should not be used as a substitute for professional diagnosis and treatment. If you have or suspect that you have a medical problem or condition, please contact your physician.