In his letter to the editor critical of my op-ed advocating a tobacco-free Stanford, Mr. Edward Ngai, an admitted smoker, appears to be a man filled with great contradictions.  On the one hand, he speaks of “the right of a stressed out student to seek relief in a cancer stick or two” and the importance of his “complete freedom” to smoke.  On the other hand, he reveals how he stumbles his way to the nearest off-campus gas station in the middle of the night for his “cancer sticks,” apparently oblivious to the degree his cigarette addiction has already stolen his “complete freedom.”  Mr. Ngai says my views are “all smoke and mirrors.” Ah…drawn to the clever metaphor when bereft of the facts.  Well, Mr. Ngai…the tobacco addict that you are…in keeping with this metaphor, you have the “smoke”…but I hold the “mirror” to the future tobacco addicts like you will face.

First, college-age smokers will likely continue their habit well beyond their school years as more people in the United States are addicted to nicotine than any other drug, with research suggesting that nicotine may be as addictive as heroin, cocaine and alcohol.  Second, after years of smoking, when the tobacco addict discovers they are consistently out of breath, their doctor will likely implore them to quit smoking.  If they heed the doctor’s warning, great.  If not, the next diagnosis will likely be lung cancer, for you really can’t screen for lung cancer.  Then, the question will be whether it is small cell or non-small cell lung cancer, and what is the stage?  If the tobacco addict waited too long to quit the habit, he very likely will have Stage IV lung cancer…rarely cured, with only the symptoms to be treated.

Under Stage IV, the cancer will have spread to both lungs, to the fluid in the area around the lungs and possibly to other internal organs.  Treatment options might include surgery, chemotherapy, radiation and targeted drug therapy.  The common symptom of being out of breath is due to the cancer having spread to the pleural space around the lungs, causing an excessive build-up of the fluid that normally provides lubrication between the lungs and the chest cavity, with this fluid build-up pressing upon the lungs causing difficulty in breathing.  Short of suffocation, the doctor likely will perform a thoracentesis procedure where a five-inch-long needle is inserted through the lower back, through the rib cage and into the pleural space of the lungs.  This procedure can only be done by skilled doctors who must miss vital internal organs as they insert the needle.  It is done with local anesthesia, so it still can be uncomfortable and painful.  The needle is connected to a drainage tube and the fluid is drained by gravity into a large container for disposal.  A thoracentesis will bring immediate relief from suffocation, but it is not a cure.  The fluid will continue to build up until another thoracentesis is required…with the frequency increasing until it is no longer effective and the tobacco addict eventually dies from suffocation.

Not a very pleasant reflection in my “mirror” about the future of tobacco addicts.  Sadly, this same terrible fate can befall those around the tobacco addicts who are forced to breathe their smoke.

Mr. Ngai, the “complete freedom” you cite comes with responsibilities and recognition of the consequences of your actions.  And, do be aware of the fact that the tobacco companies have already taken away your “complete freedom”…long before you really and truly understood what it was.

Donald A. Bentley
Master’s in civil engineering, 1982
Email: [email protected]