tobacco still kills

One of my nicest patients died last week. She always asked about Leo and how he was doing. She smoked for many years, and last year had an episode of blood in her urine. The workup showed cancer of her ureter, the tube from the kidney to the bladder. She had to have the ureter and kidney removed, then had lots of complications, including a wound infection, sepsis (the infection spread to her blood and all over her body.) She was able to be discharged and went home for a while, but she was too weak to take care of herself so went into a nursing home. Then she developed pneumonia. She did not want to be intubated (put on a ventilator), so she died of the pneumonia. But it was the tobacco induced cancer that caused her death. Some patients have been surprised that smoking can cause bladder or ureteral cancer, but some of the toxins from tobacco end up in the urine, and the ureter and bladder are constantly exposed to the toxins, and cancer is the result.

Another patient was brought in last week for a change in her personality, inability to sit still with near constant twitching, and muttering. I thought that she might have a movement disorder and sent her to a neurologist. The workup showed two masses in her brain that were likely metastatic cancer from somewhere else. Further scans showed a lung mass, so it is likely lung cancer from her smoking. The patient is now very confused and can barely get out of bed, so I suspect that she won't live much longer.

How much longer is this going to continue? Tobacco is a known carcinogen, as is second and third hand smoke. (Second hand is what others breathe in while someone is smoking, third hand is the residual left that others breathe in later - yes, that "tobacco smell" is cancer causing.) So why does our and nearly every other government let tobacco sales continue? In this country it is the tobacco lobby paying off our elected officials to continue this corporate murder. If I am every made ruler of the world, tobacco will be gone very quickly (but after equal rights for gays, lesbians, transgendered and women are written into law.)