Of dr. Mauro Pecchioli, general practitioner, involved in the fight against smoking for many years

Good morning doctor, I am 53 years old, and I started smoking at 13, with some slightly older friends who offered me cigarettes. I feel the need to confide in her to finally be able to get answers to the many problems that my condition as a smoker brings me, problems that I don't confess to anyone, but which I have resigned myself to carrying inside me in silence every day for years now.

1 Patient. Is it true that when someone starts smoking as a teenager it is more difficult to stop?
Doctor. Yes, it's true..

2 P.  Why?
M.  Because during adolescence the stimulating effect of the centers of gratification and pleasure on the part of the dopamine stimulated by nicotine one meets and firmly "marries" with very strong emotional states, unique because they are at their first onset in the individual's existence. They are characteristic of the stage of emotional development of that stage of life.
A very difficult association is created between smoking and the social successes believed, wrongly, to be due to that behaviour. The young man remains convinced that the positive and rewarding things he has achieved are only due to his appearing on the social scene as a smoker.
In other words, the belief of appearing more interesting and attractive with the gestures of smoking, without knowing the reason, i.e. the rewarding, artificial, therefore "fake" chemical/pharmacological effect of nicotine, ensures that the young person clings to that behavior that he has experienced as successful for his success in life, in relationships with others, and does not let go, also and above all for the fear of later finding himself without the "magic feather" of the elephant Dumbo. And let's not forget that once addiction has been established, breaking away is even more difficult, indeed, unthinkable, due to the suffering caused by abstinence.

3 P.  But not all teenagers will need to use Dumbo's "magic feather" to find their serenity and balance. There will also be a social factor, of belonging to particularly disadvantaged social groups and with little culture and poor ability to develop rational solutions to the various problems of insertion into society typical of adolescence. Why does one necessarily have to choose to smoke to feel accepted by the community in which he lives?
M. Certainly, situations of strong psychological distress, easily more accentuated during the almost always difficult social integration of adolescence, can be conditions that favor the fall into the "trap" of smoking, always ready and tense in the territories thanks to the tolerated and supported presence legally by the institutions of the tobacco industry.
There is a nice little story that helps describe this condition.
A beautiful caterpillar had fallen from the deck of a ship, at night, during a storm, and was floundering on the surface of the water trying to stay afloat so as not to drown.
When the sea calmed down and the moon rose, he suddenly saw a large cylinder floating near him, an excrement that had come out of the ship's exhaust.
Despite the stench and disgust it made him, he thought that at least he could use it as a lifeboat, and he got on it, finally being able to relax and unwind without worrying anymore.
When it became light, with the sun shining warmly in the blue sky, it transformed into a chrysalis, and around midday it emerged from its shell in the form of a beautiful butterfly with large, colorful wings.
At that point he would have been ready to abandon that stinking lifeboat and fly free in search of land or another ship, but he decided to stay and live on the excrement, to which he felt deeply bound by a debt of gratitude, because that he had saved his life.
This is what happens to those who, in critical moments of their life, establish a relationship of dependence, and cling to cigarettes, alcohol, gambling, or any other entity, stinky and disgusting, but capable of making them survive.

4 P.  Various images and writings are printed on cigarette packets that warn smokers of health risks, but exactly what are all these diseases caused by smoking?
 M.  According to the World Health Organization (WHO), smoking is responsible for approximately 8 million premature deaths each year, of which approximately 7 million are attributable to direct smoking and approximately 1 million to passive smoking.
The incidence percentages of smoking diseases, divided into tumors, respiratory system diseases, cardiovascular diseases, others, are as follows:

  • Cancers: Smoking is responsible for approximately 22% of all cancers, including 70% of lung cancers, 22% of laryngeal cancers, 17% of mouth cancers, 13% of pharynx cancers, and 9% of bladder tumors. However, there is no certainty that there is an organ spared from falling prey to a tumor following contact with approximately 70 carcinogenic substances, components of smoking, together with approximately seven thousand others, therefore other organs can be targeted for tumors from smoking .
  • Respiratory diseases: Smoking is responsible for approximately 75% of all deaths from chronic respiratory diseases, including chronic obstructive pulmonary disease (COPD), emphysema and asthma.
  • Cardiovascular diseases: Smoking is responsible for approximately 25% of all deaths from cardiovascular diseases, including myocardial infarction, stroke and hypertension.

It is important to note that these are general data only and that incidence rates may vary depending on factors such as age, gender, family history and other health conditions.

5 P.  If smoking is so harmful to human health, then why does the state still allow cigarettes to be sold?
M. It's a more than fair question: a first grade child can ask it. Unfortunately, the tobacco industry has a strong influence on politicians, so it is able to convince them not to pass laws against it, such as outdoor smoking bans in public places. Furthermore, it is now known that there is not even an economic advantage: the State collects around 14 billion euros every year from the sale of cigarettes, but has to spend 26 on the diagnostics and treatment of smoking diseases. When the State has politicians impervious to the siren song of the tobacco industry, then we will have laws that will convince that industry to remove its tents from our country.

6 P.  In the media, when journalists talk about cigarettes, they call the habit of smoking a "vice". What is the difference between a vice and an addiction?
M. Il vice it is only a repeated behavior that can be stopped without suffering on the part of a subject.

La dependence is a medical condition characterized by an unstoppable compulsion to consume a substance or practice a behavior, despite negative consequences. Addiction is characterized by three main symptoms:

  • Tolerance: the need to consume more and more of the substance or practice the behavior more and more to achieve the same effect.
  • Abstinence: Negative physical and psychological symptoms that occur when you stop using the substance or practicing the behavior.
  • Loss of control: the person is unable to control their use of the substance or the practice of the behavior.

In the case of smoking, it is primarily an addiction to nicotine. The nicotine it is a psychoactive substance that has stimulating and relaxing effects. It can cause addiction even at low doses.
People who smoke often start doing so out of curiosity or imitation. However, once you become addicted to the nicotine, it's very difficult to stop.
There are three things that represent the concept well dependence:

  • the barb of a fishing hook, a kind of tailstock at the top of the tip of the hook, which prevents the hook from coming out of the tissues in which it is stuck,
  • the pot, a type of net, always used in fishing, which is easy to enter but from which one cannot exit, due to the geometry of the net.
  • the idea of ​​a dress that, when worn, becomes one with the skin and becomes impossible to remove, because it would cause unspeakable suffering by tearing the skin.

7 P.   I've heard of Anti-smoking centers. What are they?
M.    They are structures, public or private, where a smoker can find therapeutic help to free himself from his addiction nicotine.
Let's take some considerations into account.

  1. The anti-smoking center is addressed to a smoker who has come to a strong awareness that he needs to stop smoking, and who is unable to do it on his own.
  2. Generally they are free as services, at least the public and private ones managed by NGOs.
  3. Drug therapies are paid, because they are not reimbursed by the NHS, and they do not even have a low cost. Therefore, quitting smoking with drugs costs money.
  4. Despite their name, anti-smoking centers are not able to eliminate smoking in a society that continues to sell cigarettes and leaves the promotion of smoking among young people free through various types of messages in the media and in public social reality. In short, while an anti-smoking center can over time discharge a smoker freed from addiction, an unknown number of new non-smokers have been captured by the tobacco industry, in an endless cycle that will never put an end to smoking.

8 P.  What is the probability of quitting for a smoker who relies on an anti-smoking center?
     Some studies have found that people who participated in a 12-week smoking cessation program, which included behavioral therapy and medication, had a 50 to about 60 percent chance of success at 12 months. Therefore, one year after treatment, only 5 or 6 smokers out of 10 treated still manage not to smoke.

9 P.    But is it possible to quit smoking on your own, that is, to get rid of nicotine addiction without resorting to drugs or medical facilities?
M.      Of course, you just have to overcome all the withdrawal symptoms caused by the absence of the substance that led you to addiction, and stop thinking that you are cool with the cigarette flaunted in public.. Nicotine is a very powerful addictive substance, and When you quit smoking, you may experience a variety of symptoms, including nervousness, anxiety, irritability, and difficulty concentrating. These symptoms are temporary and usually subside within a few weeks.

We need to organize ourselves to face this difficult, very difficult "ford" to get to the non-smoking side, but it is not impossible. I know people who have done it, and I myself quit overnight, at age 33, after eight years of smoking about 15 cigarettes a day. I suddenly realized that I no longer needed that habit, and I decided to hang up the last opened package, and throw the few other new ones yet to be opened in the trash, and I felt amazingly good about making that decision forty 'Years ago

10 P.     How can I find truthful and reliable information on the Internet about the problem of smoking?
M.          In Italian, the site most committed to providing authoritative information is certainly https://www.tabaccoendgame.it/, signed by scientific societies and also by individual citizens.
On the site we read among other things: “Tobacco endgame is also a set of strategies aimed at permanently changing the structural, political and social dynamics that support the tobacco epidemic, with the aim of ending it. "
On the social network Facebook you can use the data published on the "We want an end to smoking" page, which I personally curate based on my 13-year experience on the problem: https://www.facebook.com/vogliamolafinedeltabagismo?locale=it_IT

11 P.    I'm curious, doctor, is cigarette smoke a gas, a liquid or a solid?
M.   There is a simple home experiment to get an idea of ​​the physical state of smoking. You take a clean glass with a flat bottom, light a cigarette and let the smoke rise under the external bottom of the glass, keeping it close to you. Most of the smoke will escape into the air, but that part that will hit the glass of the glass, when the cigarette is completely consumed, will make you understand what it physically is. All you have to do is turn the glass upside down and you will see a yellowish-brown collection of a very acrid-smelling oil that is greasy to the touch. So cigarette smoke is a suspension of microscopic drops of oil in the air. Research tells us that it contains around 7000 substances, of which 250 are toxic, 70 carcinogenic.

12 P.     You see, doctor, I have sometimes thought that if they no longer sold cigarettes, I would surely be able to free myself from smoking, willy-nilly. But tell me, how do you explain that there are smokers who reach considerable ages, ninety-year-olds, even centenarians, and do not have any tobacco-related disease?
M.   It is possible that some people who smoke can reach considerable ages without suffering or showing damage from smoking, but this is due to a combination of genetic factors, related to lifestyle and the quantity and duration of smoking. In any case, research tells us that out of three smokers, two suffer damage, even fatal damage, while one remains unharmed. Therefore we can conclude that smoking is like playing Russian roulette: a revolver with a cylinder equipped with three chambers, with two bullets inserted and an empty chamber; the drum is rotated and aimed at the head. Who can be sure that he will get the shot without a bullet?

It's not worth having such stupid fun tempting fate to irreversibly jeopardize your health and life.

13 P.    I have heard that a smoker who stops smoking will have the same probability of getting sick again after a few years as a non-smoker. It is true?
M.   Let's say that in any case, stopping introducing 7000 substances foreign to our body into the blood, complete with carcinogens and toxic substances, certainly leads to an improvement in health conditions. However, the damage must be taken into account irreversible that brings the smoke:

  • DNA damage: Smoking can damage the DNA of cells, increasing the risk of cancer.
  • Lung damage: Smoking can damage the lungs, causing respiratory diseases such as chronic bronchitis and emphysema.
  • Damage to blood vessels: Smoking can damage blood vessels, increasing the risk of heart disease and stroke.
  • Teeth damage: Smoking can stain your teeth and increase the risk of gum disease.

It is important to note that these damages can occur even in people who smoke for only a short period of time.

14 P.     Doctor, we often hear it said by those who maintain that everyone must be left free to choose what they like about their life, that smokers are responsible for their own evil, because they continue to buy cigarettes, so with this reasoning the industry dumps the blame for the damage of smoking on its customers. But if those who smoke do so because they are driven by chemical dependence, and cannot do without it, how can they be able to make the choice to continue, when rather they are forced to do so because they have agreed to bite a hook that has been given to them? stuck in the flesh and can only be extracted at the cost of unspeakable suffering?
M.   In fact, let's say you've already given yourself the answer. Furthermore, one wonders whether the tobacconists are inhabitants of this planet or come there every day with spaceships from another galaxy. How can they tolerate, for example, walking on sidewalks covered in cigarette butts that their customers throw away without thinking about the consequences for the environment. If at least tobacconists put up signs in their shops inviting smokers not to smoke in the presence of minors and not to throw cigarette butts and empty packets wherever they are, they would demonstrate that they care about the health of the areas in which they operate.

15 P.     Doctor, one last question. When we hear of plans to ban smoking, for example outdoors in public environments, such as in parks, at bus stops, on station platforms, on beaches, many smokers, but also non-smokers, rise up very vehemently and begin to agitate the specter of prohibitionism. What do you think?
M.   Prohibition was a social phenomenon that manifested itself in the United States of America in the early 1900s. Prohibiting, prohibiting, is not prohibitionism. Then it would be necessary to abolish red traffic lights, no entry and no parking signs, level crossing bars, and all the other thousand rules that every society gives itself through the laws agreed to optimize everyday social life. Prohibiting behavior that leads a State to lose 12 billion euros every year, taking away resources that can be used in services useful to the community, is not prohibitionism, but an act that the leaders of a community take on the burden of making become law in favor of improvement of everyone's living conditions.

16 P.     Excuse me, doctor, allow me another question, an important one I think. What about e-cigarettes?
M.   The electronic cigarette was invented by a pharmacist obsessed with intense nicotine addiction. It was created with the aim of helping smokers to get out of addiction by reducing the doses of nicotine until they no longer feel the need. Commerce then took it over, transforming a treatment tool into a business with billions in profits. Today we have even reached the absurd point that some teenagers ask for electronic cigarettes for their birthday, despite the fact that it is proven that it represents a first step towards then taking up smoking. Some researchers have come to the conclusion that electronic cigarettes and those with heated tobacco, therefore containing in any case nicotine, which is addictive, would be ten times less harmful to health than traditional cigarettes. Thinking as a judge, would you acquit a defendant accused of killing just one person and condemn someone who killed ten? Not a chance. The tobacco industry advertises this move as a step forward in the search for the least harm, but for a society of civilized people, regarding a useless trend, useful only to make money for a criminal industry, the least harm is not admissible, the damage MUST NOT EXIST, as it is only a luxury fashion, non-essential and non-vital.

Therefore the electronic cigarette must be used only for therapeutic purposes, as they decreed in Australia, where just last year they banned the recreational use of any type of electronic cigarette.