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Dr.Hays

Chest pain

Posted by Dr.Hays Aug 16, 2017

Chest pain is a frightening symptom because it is so closely associated with heart attack; however most chest pain people experience is not from a heart attack, but due to other causes such as injury to the ribs, tendons, or muscles in the chest wall, or from the esophagus or stomach, often caused by acid indigestion. 

 

Warning signs that chest pain may be more than just indigestion include: pain lasting more than a few minutes; pain associated with shortness of breath or dizziness; pain that comes on with exertion and is relieved by rest; pain or pressure that radiates to the neck, shoulder, or back; or chest pain occurring in someone who has a history of heart disease, stroke, or peripheral vascular disease. Chest pain with these features or any chest pain that does not resolve on its own in several minutes should be checked out by a health professional.

 

Although chest pain is not more common among people who have recently quit smoking, it is true that among current or former smokers most chest pain should be taken seriously since people who smoke are at greater risk of heart disease, heart attack, and sudden death due to a cardiac event.  Stopping smoking can rapidly reduce the risk for heart attack, with the risk going down by one-half in the first year, and down to no increased risk level after 3 years of stopping smoking. 

 

Making a plan to stop smoking and sticking with it is the best way to a healthier heart.  Use BecomeAnEX.org Cardiovascular Disease information and other resources to support you.

Dr.Hays

Smoking and Hypertension

Posted by Dr.Hays Aug 9, 2017

People with hypertension (high blood pressure) who smoke are at serious risk for a number of health problems, in addition to the many illnesses to which all smokers are vulnerable.  When smoking is added to hypertension, and high cholesterol the risk of heart attack, stroke, and sudden death increases more and more.  Smoking also hastens the development of renal disease and other organ damage that can occur from chronic hypertension.  Still about 20% of people with hypertension in the United States continue to smoke.

 

Carbon monoxide, nitrogen oxide and a number of free radicals are some of the compounds in cigarette smoke that can damage the circulatory system and increase the health risks for people with hypertension. Like for all people who have tobacco dependence, a combination of medication and counseling or support is the most effective ways for stopping smoking.   However, some people might be concerned that medications could worsen blood pressure. 

 

Many studies have found that nicotine replacement seems to be quite safe for people with hypertension.   Nicotine can cause constriction of the blood vessels, and nicotine replacement can increase blood pressure for non-smokers, but studies with smokers have found that blood pressure does not increase when using nicotine replacement, probably because they have developed a tolerance for nicotine from smoking.  And nicotine replacement will make success in stopping more likely.

 

Bupropion and Chantix are two non-nicotine medications that are effective for stopping smoking.  Chantix has been found to have no effect on blood pressure, but bupropion can increase blood pressure in some people.  People who want to take bupropion for stopping smoking should have a discussion with their health care provider about this if hypertension is a concern.

 

If you have hypertension, you’ll be well served by stopping smoking.  Becomeanex.org, phone or in-person counseling options, and/or your health care provider can give you the support and expert advice that can help you quit for good.

Dr.Hays

Chantix vs. Wellbutrin

Posted by Dr.Hays Aug 2, 2017

Are you worried you will choose the wrong medication? How do you determine what is the best option for you?

There are two medication options that do not include Nicotine; these are Varenicline (Chantix) and Bupropion (Zyban or Wellbutrin). 

Varenicline:

  • Varenicline (Chantix) was designed specifically to interact with the nicotine receptor in the brain. It was patterned after an old medication called cytosine. Cytosine was thought to block the nicotine receptor but cytosine did not have great results for smoking cessation.
  • Head-to-head tests of both Varenicline and Bupropion show that Varenicline results in higher smoking cessation rates.
  • The most common side effect due to Varenicline is mild nausea and for bupropion it is sleep disturbance.

Bupropion:

  • Bupropion (Zyban or Wellbutrin) was initially developed and currently used as an antidepressant, and through the almost accidental observations of a psychiatrist at a California VA hospital, was found to reduce smoking in people who were taking it for depression.
  • Bupropion may reduce the weight gain often experienced by people after they quit smoking; and it may reduce the negative moods often experienced after smoking cessation. Varenicline does not appear to have these positive effects.
  • Bupropion may interact with other drugs that may require adjusting the dose of these medications. Varenicline has no important interactions with other drugs.

Both Varenicline and Bupropion:

  • One study showed that combining the two drugs resulted in higher smoking cessation rates for heavier smokers (over 20 cigarettes per day) when compared to taking Varenicline alone.
  • Either drug can be combined with Nicotine Replacement Therapies (NRT); this may boost the smoking cessation rates when compared with Varenicline or bupropion alone.

 

Choosing which medication may be right for any given person requires weighing the potential benefits and differences in the medication to find the best fit for a particular person. Your doctor should be able to help with this decision. All things being equal, Varenicline may be the best choice for many smokers since it is associated with the best smoking cessation rates.

Many folks are convinced they perform their best — at work, in artistic pursuits, in life — when they’re smoking. As a painter and writer one said, “Smoking makes me more creative.”

 

Does it really?

 

Nope.

 

If you believe you do your best work while smoking, you’re giving cigarettes too much credit. A cigarette won't plant an idea in your mind that wasn’t already sprouting.

 

Smoking may seem like critical to your creative process, but in reality, it’s a distraction.

 

Every time your nicotine levels drop and the urge to smoke hits, you’re forced to interrupt your work — whether or not you’re on a roll. Your addiction always comes first!

 

In fact, you start becoming distracted even before the nicotine craving strikes. When your brain relies on the drug to keep you feeling “normal,” your concentration starts waning after about an hour. Soon enough, you’re thinking about your next cigarette — not the texture of your painting.

 

When you quit smoking, you might feel a bit “off” for a bit, but before long, you’ll get into a better, sharper, more productive groove.

 

That painter I mentioned? Much to his surprise, once he quit smoking, he became more prolific. “I actually have a portfolio,” he said, “rather than just wishing I had one.”

 

Do you fear that quitting smoking will compromise the quality of your work? Or that you just won’t feel like yourself when you quit?

 

Please share and experiences!

Many smokers fear that when they quit, withdrawal will never end. They’ll say, “What if I’m always miserable?”

 

That’s a natural concern. After all, nicotine cravings are real, and they’re not fun! But this doesn’t mean you’ll be plagued by cravings — or that they’ll be strong enough to drive you back to smoking.

 

Here are 3 ways to minimize how hard cravings hit and how long they last.

 

  • Use nicotine replacement therapy (NRT) with a strong enough nicotine dose. When smokers say, “The patch didn’t work” or “the gum didn’t help,” it’s often because they chose a patch with an inadequate nicotine dose or didn’t chew their gum on schedule. A trained tobacco specialist can help you use NRT correctly.
  • Don’t quit medication prematurely. Some newly quit smokers, emboldened by their success, ditch their medication when they’re still highly vulnerable to relapse. Remember: It’s smoking, not medication, that poses a danger!
  • Don’t expect medication to eliminate cravings. Even after nicotine has cleared your body, you can be tripped up by habit or emotional triggers. Be prepared! Learn alternative ways to occupy your hands, mouth, and mind, and work on replacing old routines with new ones.

 

You might hear former smokers say they still “crave” cigarettes years after quitting, but they’re not talking about “my chest is going to explode” feeling common in the first few weeks. They may occasionally think, “A cigarette would be nice right now,” but they quickly move on.

 

As one former smoker put it, “My fear of suffering was far greater than my actual suffering.”

 

Let us know: If you’ve relapsed recently, ? Next time around, what will you do differently to ease withdrawal?

 

If you’ve quit for good, how long did it take for your regular cravings to stop?

Have you ever stashed cigarettes in the closet or the freezer just before quitting?

 

Some smokers reason that a secret stash will give them “peace of mind” to focus on quitting, kind of like a security blanket. Others believe quitting in the face of temptation will only make them stronger.

 

This is faulty reasoning!

 

Keeping cigarettes around when you quit is not empowering; it’s sabotage.

 

If cigarettes are just a drawer pull away when a craving hits, you’re likely to act on impulse. You probably won’t stop and think: I’ve saved $350 this month not smoking or I’m really going to regret blowing my quit.

 

Nope, in the moment, when your chest is tightening or your mouth is watering, you’ll tell yourself: Eh, what’s one cigarette going to hurt?

 

Of course, “just one smoke” leads to another and another. . .

 

Sure, you can always head out to buy cigarettes, but unless you live next to a convenience store, making your purchase will take more than 5 minutes, which is how long a craving typically lasts. That 5-minute buffer is important. It gives you the time to think more clearly.

 

The problem with hiding cigarettes goes beyond temptation. It’s sending the wrong message to yourself. If you keep a pack hidden “just in case,” you’re conceding that you might smoke again.

 

You’re giving yourself an out — essentially preparing to slip up.

 

Instead, prepare to succeed by making a firm commitment to quit! Go full steam ahead, and destroy or give away every cigarette and ashtray you possess. Show yourself that you mean business — that you’re not just trying to quit. You are quitting.

 

What if you relapse? You’ll deal with it. Chances are, you’ve dealt with setbacks before. Most ex-smokers have blown a quit — or 20.

 

What’s important is committing 100% right now.

 

If you’re an ex-smoker, let us know: What did you do with your cigarettes right before you quit? What advice do you have for folks who are in the process of planning their quit?

Have you ever considered your cigarettes a friend? Does the prospect of giving up cigarettes make you feel sad or lonely?

 

These feelings are common among longtime smokers, and they won’t last forever, but it’s important to acknowledge and address them, so you can put 100% effort into quitting.

 

Our community is a great place to explore sadness or ambivalence about quitting — feelings that people who’ve never smoked may not understand or may even dismiss outright.

 

Some smokers don’t recognize their bond with cigarettes until they get serious about quitting. That’s when — in search of reasons not to quit — they start thinking: Cigarettes don’t pass judgment me. They don’t argue with me. They’ve always been there for me, through thick and thin. They are my loyal companion.

 

True enough! But let’s explore this notion further. If cigarettes are your friend, just what kind of friend are they?

 

In truth, they’re a “friend” that spends your hard-earned money, compromises your health and your pet’s, sucks up your time, invites dirty looks,  and exiles you from restaurants!

 

The reality is, cigarettes control you, demanding your time and attention throughout the day from when you wake up to when you go to bed.

 

Leaving an unhealthy relationship is never easy, but we’re all capable of it. Here are three approaches many smokers have used with success:

 

  • Write a “Dear John” letter to your cigarettes. For instance: “Dear cigarettes: You are stealing my money, my singing voice, and my stamina, and you make my car smell! I cannot be your friend anymore. Goodbye.”

 

  • Come up with a mantra to repeat whenever you feel the urge to smoke. For example: “You are not my friend; you are my enemy.”

 

  • Focus on the ways cigarettes have hurt your actual friends and loved ones. As one smoker put it: “You killed my grandfather and strapped my father to an oxygen tank. You are not going to do that to me. You are not my friend.”

 

Which, if any, of these strategies resonate with you? How will you break off your “friendship” with cigarettes?

Dr.Hays

NOPE, not one puff ever!

Posted by Dr.Hays Jun 28, 2017

Quitting smoking takes everything you have — all your focus, energy, and resolve. But once you’re “over the hump” and not fighting daily to stay tobacco free, you might let your guard down.

 

Maybe you’ll be hanging out with friend who smoke and think: I’m not addicted anymore. I can handle a puff.

 

Maybe after a stressful workday you’ll rationalize: What’s the harm? I’ve got 2 years tobacco free.

 

Maybe you’ll reward yourself for quitting by having “just one cigarette.”

 

Beware! Just when you think you’re no longer vulnerable to relapse — well, that’s when you are most vulnerable, especially if you’re drinking alcohol or dealing with stress or illness.

 

I’ve known former smokers who relapsed a decade or more after quitting. One woman, who’d quit smoking at age 28 relapsed at age 48! In the interim, she’d become a diehard non-smoker repulsed by the odor of cigarettes. Then one day, while at a bar on vacation, she impulsively bummed a smoke in a bar, figuring: I’m in control. This isn’t a problem.

 

Soon she was smoking a pack a day and trying to hide her addiction from her family. It was another five years before she quit for good.

 

As an ex-smoker, you must live by the NOPE rule: Not one puff ever.

 

Here are 5 ways to stop yourself from taking that fateful first puff.

 

  • Notice the moment risky thoughts surface, so you can act before your judgment gets too clouded. Tell yourself: I can feel myself heading down the wrong path!

 

  • Text or call a friend to talk you out of it.

 

  • Wear a rubber band or other reminder around your wrist. When temptation bubbles up, tug on the band to snap yourself back to reality.

 

  • Keep a counter-argument in your wallet or on your phone. For example: “Quitting has saved me $4,000 a year” or “I can keep up with my grandson!”

 

  • Visualize yourself as a smoker again: You’re worried about flight delays, how your clothes smell, whether you have enough cigarettes. Now imagine starting the quitting process over again.

 

           

Have you relapsed after taking “just one puff”? Tell us your story!

Do you fear it’s impossible to quit if you share a home with smokers?

 

It’s a challenge, to be sure. You may be frequently faced with temptation, and you may worry about offending the smokers you live with. As one former smoker put it: “I felt like I was saying, ‘By the way, I’m better than you — I don’t smoke.’”

 

Yet plenty of people who live with smokers are able to quit for good! Here are steps you can take to boost your odds of succeeding.

 

  • Negotiate house rules, ideally before you quit.

 

Don’t leave anything to chance! Let’s say your partner smokes on the deck every morning after breakfast, triggering you to light up in the car. Ask your partner to smoke in a different location, such as the back yard, or at a different time, like while you’re showering or after you leave for work.

 

If those you live with won’t agree to stop smoking in the house, designate one smoke-free room or, better yet, limit smoking to a single room. Ask them to keep cigarettes and ashtrays out of sight and not to smoke in the car with you.

 

  • Ask your housemates not to offer you a cigarette or let you bum one.

 

Of course, the responsibility to avoid cigarettes is yours, not theirs, but you certainly can enlist their help. Instruct them to say: “Sorry, you asked me not to let you bum a smoke and to remind you to pull out your list of reasons for quitting.”

 

  • Leave the room — or the house.

 

If you can’t avoid a housemate who’s smoking, don’t make yourself miserable — or vulnerable to relapse. Go elsewhere, and keep your hands, mouth, and/or mind busy. Give yourself a manicure or chew gum while you listen to a podcast.   

 

During those first few weeks, plan to spend less time at home. Visit the library or make plans with non-smoking friends. Go for a bike ride. Walk around the block.

 

Once you’re over the hump, you may find that living with a smoker actually strengthens your resolve to stay tobacco free. As one former smoker put it, “Listening to my wife cough every day is a huge motivator for me to never smoke again.”

 

If you quit while living with smokers, what advice do you have for others?

Dr.Hays

Fear of Gaining Weight: Part 2

Posted by Dr.Hays Jun 14, 2017

In a previous post about weight gain, I explained that while most smokers do pack on at least a few pounds after they quit, weight gain is not inevitable and certainly can be temporary.

Here are some strategies to avoid or minimize weight gain while you work to maintain your hard-earned quit. You can find additional strategies in our post titled Back to Blogging and Weight Management the "Mindful" Way

  • Plan what you’ll put in your mouth — besides a piece of chocolate! — when you experience a craving. Chew sugar-free gum, a straw, or a cinnamon stick.

 

  • Examine the emotional needs smoking filled for you, such as coping with stress or boredom, and learn ways to cope that don’t involve eating. For example: deep breathing, calling a friend, listening to a podcast, or posting on EX Community.

 

  • Don’t skip meals or deprive yourself of favorite foods. A restrictive diet will only make you more irritable and vulnerable to relapse.

 

  • Choose fresh fruits and veggies over processed snacks. Not only are baby carrots, tangerines, and apple slices more nutritious than, say, energy bars, but all that munching, peeling, and slicing will help keep you busy and distracted.

 

  • Stay active. Think smoking gives you pleasure? It’s no match for the sheer joy of taking a brisk walk without huffing and puffing! Start small: Use the stairs instead of the elevator, replace your smoke break with a 10-minute walk, walk the sidelines during your child’s sports game. Exercise keeps you busy, lowers stress, and burns calories all at once.

 

We don’t recommend trying to lose weight in the first few months after you quit smoking. Channel your energy into staying tobacco free. You have the rest of your life to lose weight, if that is a goal for you.

 

However, while you focus on quitting, there’s plenty you can do to keep your weight stable.

 

Let us know: What weight-control strategies do you plan to try? If you’ve already quit, what are your best tips for avoiding weight gain?

Have you put off quitting, or relapsed after a quit, because you fear gaining weight?

 

In this post I aim to help you overcome that fear, so you can focus on what matters most: overcoming . In a future post, I’ll discuss strategies to avoid or minimize weight gain once you quit.

 

It’s true most smokers put on weight after they quit. Nicotine suppresses appetite and elevates metabolism, so when you quit, you’re hungrier, and your body returns to a normal metabolism. Plus, your taste buds and sense of smell come back to life, so food is more appealing. Also, with cigarettes out of the picture, many folks use food to occupy their mouths and cope with stress.

 

But remember: While weight gain can be temporary, the effects of smoking may not be. Extra weight will not cause COPD, or lung cancer! And though excess weight does increase the risk of developing or aggravating diabetes, so does smoking.

 

At any rate, weight gain is not inevitable! About 16 percent of smokers actually lose weight when they quit, according to a review of 62 studies published in the British Medical Journal. Another 37 percent of quitters gain less than 11 pounds). Many folks feel so empowered by quitting and inspired by their newfound stamina that they start exercising and eating more healthfully.

 

If fear of weight gain is holding you back, start noticing your negative thoughts about your weight. Ask yourself: Are these thoughts accurate? Could they be excuses to keep smoking?

 

Let’s say your jeans fit more snugly, and you think: I’m worse off now than before I quit or My co-workers will think less of me if I gain 10 pounds.

 

Challenge these ideas!

 

Even if you have to buy a larger pair of jeans, are you truly “worse off” than when you were addicted to ? If a co-worker of yours gained 10 pounds after beating tobacco, would you think poorly of her? Or would you congratulate her on her tremendous accomplishment?

 

I think you know the answers.

 

Counter each negative thought with a positive one. For example: Now I don’t feel like an outcast at work, and I’m saving $250 a month!

 

If you’ve experienced anxiety about weight gain, please share your thoughts with the community!

More than 40% of smokers under the age of 18 smoke menthol cigarettes. The FDA has concluded that although menthol itself does not cause disease, it makes cigarettes more palatable.  Thus, menthol in cigarettes posed a public health risk.  The FDA is currently considering regulating menthol in cigarettes.  So, why all the “fuss” about menthol cigarettes?  What concerns are there about these tobacco products?  Let’s just consider a few facts about these products.

 

39% of menthol smokers reported they would quit smoking if menthol cigarettes were banned.  Prevalence of menthol cigarette smokers is higher among African-Americans, younger, and female smokers.  African American smokers favor mentholated cigarettes by a 3-fold margin.  Menthol cigarette smokers had significantly lower odds of stopping smoking than non-menthol users. 

 

Menthol cigarette use was associated with increased concentration of blood cadmium (a carcinogen) and higher levels of Carbon Monoxide with having smoked fewer cigarettes.  Women who smoked menthol cigarettes showed signs of greater tobacco dependence than non-menthol smokers.  Young people who first tried menthol cigarettes are at greater risk of progression to regular smoking and tobacco dependence. 

 

Tobacco companies continue to perform active research to identify the product that would be least “irritating” to the throat and most addictive to promote lifelong use of their product.  Menthol cigarettes are a “perfect” fit.  They entice people to smoke and keep people smoking cigarettes – the only product that will kill more than 60% of its consumers

Hello EXers,

 

I apologize for having disappeared during the past six weeks.  Frankly we were short on staff and not able to keep pace with the weekly blogs.  We’re back up to full staff and we plan to be back to our regular blogging schedule.  Here is some food for thought for our first week back:

 

Mindfulness, a concept originating from Buddhism and other eastern spiritual traditions, has gained a great deal of attention in recent scientific research.  Mindful eating involves deliberately tuning in to your own inner experiences; including thoughts, feelings, and behaviors. With this focus, you begin to be more aware of the sensory aspects of eating, such as the taste & texture of food, when you feel hungry and full, and whether you are actually hungry or just bored, anxious, sad or angry.

 

Below are some mindful principles that can help you manage your weight when you quit smoking.

 

  1. Control portions. people eat much more food when given unlimited quantities. Try to purchase food in smaller packages and use smaller serving dishes.
  2. Eat when you’re hungry. Let actual hunger cues, not emotions, guide you’re eating. Substitute a quick walk for a snack until actual hunger sets in. Do you eat while multitasking, such as watching TV, texting, driving, or working? Do you gulp the food down quickly without really tasting it? Begin to notice your automatic patterns & habits around eating that stop you from being fully present.
  3. Plan. Prepare healthy snacks ahead of time to eat throughout the day. A 200-calorie, whole grain, high-fiber snack can satisfy hunger between meals.
  4. Keep a food diary. Write down everything you eat and what was happening at the time to identify food triggers – hunger, stress, excitement or boredom.
  5. Slow down.  During each meal, chew slowly, savoring each bite; put your fork down between bites. This gives the body enough time to signal to the brain that it’s satisfied, not stuffed.
  6. Pay attention. Don’t eat in front of the TV or computer, while standing at the kitchen counter or talking on the phone. This can lead to losing track of how much you’ve eaten.
  7. Use technology. There are now apps that manage food records, count calories, help you track what you eat and even provide guidance on healthy food choices at the grocery store and restaurants.

 

The process of quitting smoking and lifestyle change can be long and sometimes difficult. Begin by trying to accept and love yourself right now, as you exist in this moment.  Give yourself credit for all that you are doing! Make a list of your reasons for wanting to be healthier and carry it with you. Focus on the realistic benefits you can achieve when you quit smoking such as improved health, mood, and energy. Imagine yourself in the future living a more vibrant, energetic life without smoking.

Dr.Hays

Stress and resilience

Posted by Dr.Hays Feb 15, 2017

Often we think of stress as something that is happening to us: too many demands, situations that aren’t resolving as we hoped, or a series of unfavorable events. However we might benefit from seeing stress in a different light, as how we react to events, rather than how events are happening to us.

 

Our body provides us with one underlying mechanism to address emergencies or ‘stressful’ situations. When challenging events happen, our sympathetic nervous system (SNS) becomes activated. At its core, this system is designed to focus our energy to manage potentially life-threatening situations. When faced with a difficult or ‘stressful’ situation, a cascade of neurochemical messengers and hormones signal our heart to begin racing, our pupils to dilate, our digestive system to slow and our mind to more narrowly focus upon danger. This response is more fitting to being surprised by an animal in the jungle rather than to reacting to ‘stressors’ of the modern day like needing to balance a checkbook, or organizing a busy workday. Many ills of our modern day can be attributed to an overactive SNS –flailing to address crises or stressors with a system built for different types of demands.

 

But there is a solution. The mind and body are equipped with a cognitive ability to reappraise threats and a parasympathetic nervous system (PNAS), which can turn-off the SNS with a relaxation response. Good stress management can be understood as using our reasoning to realistically appraise the demands in our life, and most importantly, building our ability to activate our PNAS. With our patients we try to formulate specific goals for recreation, physical activity, enjoyable social connections, and practiced relaxation such as deep breathing or meditation; all of which strengthen the PNAS.

 

There are many good books on resilience and stress management, some of which you might recommend in comments. One I would recommend is ‘Why Zebra’s Don’t Get Ulcers’ by Robert Sapolsky. Now in it’s third edition, the book provides a very accurate scientific description in a fun easy to read format.  

 

I would like to hear from you about strategies you have found helpful to manage stress and develop your 'relaxation response'.

A colleague of mine recently asked about a good book on the history of tobacco. She was especially interested in the battle waged to establish the scientific evidence about the health effects from tobacco use within the context of tobacco industry deceit and public relations efforts.  At the risk of providing TMI, I shared 3 titles (among a dozen I might have suggested).  I thought our community members might also be interested. 

 

Richard Kluger won the Pulitzer Prize for his extraordinary book: Ashes to Ashes: America's Hundred-Year Cigarette War, the Public Health, and the Unabashed Triumph of Philip Morris.  The book has been called a tour-de-force, and I found it to be captivating and compelling.  Kluger narrates a sweeping history of tobacco from it's discovery in the 'New World' through its development as a financial behemoth.  He focuses on the 20th century battle for truth about tobacco and health by looking at the political, financial, medical, legal, social, and marketing issues through the eyes and actions of the key players involved in this fascinating story.

 

Another enjoyable read, published in 2007 is The Cigarette Century: The Rise, Fall, and Deadly Persistence of the Product That Defined America by Allan Brandt.  The cigarette century is identified as the 20th century, in which 100,000,000 people died from tobacco ( THE TOBACCO ATLAS) and it takes the reader through to the early 21st century in which the World Health Organization predicts a death toll of 1 billion people, 10 x greater than the 'cigarette century.'  Dr. Brandt provides a clear view into the strategies and tactics used to cloud the truth and allow this enormous human tragedy to unfold.

 

One last book I would recommend is The Cigarette Papers by Stanton A. Glantz, John Slade, Lisa A. Bero, Peter Hanauer, Deborah E. Barnes, and C. Everett Koop.  It gives the real time history of the investigation and fact-finding from secret documents smuggled from the tobacco industry which gave the first shocking glimpses into the planned deception of the public regarding the dangers from tobacco and the extensive effort to develop a more addicting product. 

 

Or if you would rather just watch a good movie, The Insider with Russell Crowe, and Al Pacino tells the true life story of Dr. Jeffrey Wigand.  He was a Senior Vice President of a tobacco company.  His courageous defection from the  industry and subsequent truth telling cost him a great deal personally, but gave us access to those documents.  

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