Dr. Patrick Turnes, Healthy Hampshire

Frequently I counsel individuals to stop smoking. Not infrequently, I will hear about a friend or family member who smoked all his or her life, died in his or her 90s and never had lung cancer, COPD or other smoking-related illness. If I had a dollar for every similar story I’ve heard over the years, I could retire.

Without getting excessively philosophical, I would maintain that much of life is based on randomness and probability. Much of our health is genetically driven and we have no control over our genetic inheritance.

Measurements of biological variables frequently follow what is known as the random distribution or “bell” curve. A perfect example of one of the “skinny ends” of the curve is my late mother.

She had a cholesterol level close to 300. Also, in addition to the brief time she did smoke, she was also exposed to second-hand smoke a good portion of her life. Despite that, she never so much as had a whiff of heart or lung disease and she lived to the ripe old age of 85.

On the other “skinny end” of the bell curve, there are instances of people who have developed and died of lung cancer, who neither smoked nor had other environmental risk factors.

That’s where things get interesting. When one hears of a non-smoker acquiring lung cancer, a not-uncommon reaction is, “That’s not fair.” It isn’t, but it implies that it’s less unfair for a smoker to get cancer. It’s as if the smoker is “guilty” and receiving some type of retribution, and is therefore not as deserving of our sympathy. I’m not sure that’s a reasonable viewpoint.

First, the vast majority of people who smoke don’t get lung cancer (and no, that fact should in no way encourage people to start or continue smoking). Second, many older individuals started smoking and subsequently became nicotine addicted before it was belatedly disclosed that smoking increased COPD, heart and cancer risks.

So, if there is any guilt involved in these situations, it falls on the tobacco companies. Past litigation has established their responsibility in this regard.

We should not be any less sympathetic toward someone with a lung cancer diagnosis even if it is smoking-related. It is bad enough having that diagnosis without having a stigma attached to it. 

Anyone these days who starts smoking is taking a calculated risk with their health and mortality, and it’s a bad bet. Besides the heart risks, risks of oral cancer, esophageal cancer, kidney cancer and circulatory problems (and this is an incomplete list), the lung cancer risks are significant with tobacco use and those risks are proportional to length of time smoking and number of cigarettes smoked per day.

It is now recommended that people aged 55-80 who have smoked 30 or more pack-years (number of packs per day multiplied by number of years smoked), and either continue to smoke or have quit less than 15 years ago, get screened with a low dose CT scan of the lungs to determine if there is early, non-symptomatic lung cancer. A significant number of cancers detected by this exam are potentially curable.

Finally, one’s health and management of it does not just impact the involved individual. Unless you’re a hermit avoiding all human contact, your health impacts your friends, family and the community.

A prolonged illness can wipe away savings. A premature death of an individual who may be the sole source of income deeply affects his or her family.

Dr. Stephen Hawking is an example of someone on the skinniest end of the bell curve. He had ALS and survived far longer than most people with this diagnosis. Given the scientific contributions he made in his life, imagine what more he could have done not only had he lived longer, but if he had not had this terrible, physically confining illness.

Years ago, I was listening to a then recently released album by Jefferson Airplane (yeah, a long, long time ago). It was a minor cut that was not heard on the radio. At the end of the song, one of the performers bellows in the background, “No man is an island.” After a brief pause, and in a softer voice, another member of the group replies, “He’s a peninsula.” 

As best as you can, keep the human peninsula in good order.

Along with family practitioner Dr. Andrew Wilcox, physician assistant Karen Kimmel, and nurse practitioners Missy Strite and Angelina Musselman, Dr. Turnes practices at the Valley Health Hampshire Memorial Hospital’s Multispecialty Clinic. Opinions expressed in this article are those of Dr. Turnes.

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