Smokers Unite

Smokers Unite!

“Good afternoon, and welcome to Wellness Today, your daily outlet for quality information on health and wellbeing. 

“I’m your host, Cameron Baldwin, and today we have a very special guest, Doctor Englebert Higglesby, a tenured professor at James Hopkington Medical School, the leading medical school in the Americas, and an expert in disease management and consumption epidemiology, a new field that Doctor Higglesby has innovated with funding from various international sources, including the World Health Organization, the Kingdom of Saudi Arabia, and the Sultan of Brunei. Doctor Higglesby, it’s a pleasure: Welcome to the show!”

Audience applause erupts in the Owings Mills, Maryland television studio, and, then, on cue, subsides.

“Thank you for that warm welcome, Mr. Baldwin--”

“Please, call me Cameron.”

“All right, I will, as long as you keep calling me Doctor Higglesby.”

Audience laughter.

“I sure will Doctor Higglesby.”

“Right, so, as I was saying, thank you for that warm welcome and excellent synopsis of my current work. It is truly my pleasure to join you today.”

“So, to kick things off, Doctor Higglesby, can you please explain what ‘consumption epidemiology’ is, and how does it differ from traditional epidemiology.”

“Certainly. Broadly speaking, traditional epidemiology falls into three categories: Analytic, Descriptive, and Experimental, and sometimes these cross-over. For example, what began as an Analytic exercise became Experimental once the Wuhan lab leak took place in with COVID-19.

“By contrast, my studies focus on disease states arising from external factors – and very importantly – the absence of certain factors, both over time and across large population sets. 

“The effort is intended to analyze the root causes of heretofore unexplained phenomena that have risen to the level of an epidemic, not as a result of other biological organisms per se, such as viruses and bacteria, but rather as a result of consumption choices made within the population itself. Therefore, we conduct no experiments. Instead, we make observations of segments of the population over time, using both available data and, in some cases, by tracking small, representative subsets of the population over time.”

“So, just so I am clear, Doctor Higglesby, by ‘consumption’ are you referring to food, primarily?”

“Yes and no. Food and other forms of nutrition are both necessary for vitality and essential for survival. We tend to think of consumption as ‘anything you put in your body,’ and so while that certainly would include food that you eat, we also have expanded the definition to include all types of ingestion, irrespective of whether it goes in the mouth or not, and therefore irrespective of the metabolic process of the body that is implicated in the process; i.e., digestion in the case of food.”

“That’s very interesting, Doctor Higglesby. Could you give us an example of what you mean that is not food?”

“Yes, of course. In addition to food, consumed orally and metabolized through the digestive system, we tend to think of compounds that are inhaled, and therefore metabolized through the respiratory system, or injected directly into the blood stream as other categories of interest.”

“And what is the currently of greatest interest?”

“Well, since you mentioned food, I am sure everyone is starting to get hungry, and I would say that the food you eat is a major factor, both in terms of the nutrition choices themselves, as well as the volume that is consumed. In fact, volume of consumption may turn out to be the most determinative factor regarding health and wellbeing, irrespective of the nature of the compound. But, as you well know, over the past several decades, we have developed an obesity epidemic, and I have been most interested in understanding the root causes of that.”

“I see. Tell us more about what you have concluded or are learning, please!”

“It turns out that in 1965, about 42% of the adult population were smokers, and that figure has, over nearly sixty years, plummeted to about 12% currently.

“While the CDC and the WHO have lauded this change as a success, largely the result of vilification of the practice, as well as increasingly stringent legislation making it illegal to smoke below the age of 21, when most smokers started as teenagers in throughout the last century.

“While they were celebrating this feat as a form of enlightenment, very few people have correlated the concurrent phenomenon that has occurred during this same time frame with respect to obesity.”

“Doctor Higglesby, can you please say that again, this time in English?”

There is a pause for momentary audience laughter.

“Let me put it to you this way: While the percentage of the smoker population fell by 30 percentage points over the past sixty years, roughly, the proportion of the U.S. population that is obese has tripled. The percentage of the U.S. population, including children, the ones we tend to be most concerned about protecting, that is now overweight or obese is nearly 70%. The National Institutes of Health report that 43% of Americans are obese, and 10% are morbidly obese. An additional 27% are overweight.

“In the early 1960s, the obesity rate of the population was about 13%, with severe or morbid obesity representing only 1% of the population.

“To go from 13% to 43% is a 30 percentage point gain, growth by a factor of more than three, while the morbidly obese subset has gone from 1% of the total population to 10%, a ten-fold increase.”

“But Doctor Higglesby, how do you explain the co-incidence of obesity with smokers?”

“Lack of discipline.”

“Lack of discipline? I do not understand. Please elaborate.”

“This is where the issue of volume of consumption becomes a factor.”

“Okay, but what about people who smoke too much? That can’t be good either.”

“Exactly right. It turns out that modern medicine is misguided in multiple ways, and it goes back to the Hippocratic Oath, ‘First do no harm.’ When one thinks about it, it is a ridiculous admonition. Are you doing harm when you cut through the abdomen of a pregnant woman for a cesarean section to deliver her child? Yes, of course you are: If there were no harm, there would be no need for sutures to repair the incision. If there were no harm, then the abdominal muscles of the mother would not result in the painful healing process. 

“Rather than telling us to ‘Do no harm,’ I believe we should be prescribing another Ancient Greek admonition in the form of the Aristotelian Mean.”

“What do you mean, ‘the Aristotelian Mean’? And, please, don’t be mean to me for asking.”

Audience laughter.

“Oh, I’m not mean at all. I don’t even know what that means. But I can tell you about the Aristotelian Mean: It is the notion that the mean between extremes is the fundamental guiding principle for how we ought to live.”

“No pun intended, but, in real life, what does that mean?”

“Let me give you a non-medical example to illustrate the point. We are all familiar with Smokey Bear, right? This was the USDA Forest Service iconic public service program in which Smokey Bear, the program’s mascot, would declare, ‘Only you can prevent forest fires.’ The problem with the program is that forest fires are a natural part of forest ecology. In fact, the program was discontinued, or as the Forest Service put it, Smokey Bear ‘retired’ at age seventy-eight. So for nearly eight decades, the federal government indoctrinated the population, spanning multiple generations, with the misguided notion that we should be preventing forest fires, when, in fact, we should not have been preventing them, because by doing so, we were only packing the powder keg for a series of much larger and more damaging fires than we would have had if we had not done so. The argument that preventing ground fires promotes crown fires has been validated. The policy was misguided in the first instance, and now it has been reversed. I believe the vilification of smoking, just as the Smokey Bear campaign, are analogously misguided public policies.”

Silence for a beat. No audience response.

“My goodness, next you’re going to be telling us that black is white and white is black!”

“Actually, I do have patients that illustrate that point as well. A so-called white, i.e., Caucasian, patient of mine has the surname Black, and a so-called black; i.e., African American, patient of mine has the surname White. So, there you go, White is black, and Black is white.”

Audience quiet laughter and murmuring ensues.

“So let’s get back to your original point, which was …”

“Well the original point is that over the past sixty years, as it systematically sought to make smokers the pariahs of society, the government spurred an obesity epidemic. The data are shockingly correlated: Smokers went from 42% of the population sixty years ago to 12% today. The obesity rate went from 13% to 43%.

“But let’s also consider the benefits of nicotine more broadly. Nicotine, the active ingredient in cigarettes, the ‘drug,’ if you will, is a stimulant. Both by itself and in conjunction with caffeine, another stimulant, it helps to increase the body’s metabolic rate, and it is a very effective laxative. If you want to control for obesity, in addition to making smart food consumption decisions, you also have to move your bowels!”

Uncomfortable audience laughter.

“I suppose that makes sense. But, let’s stay away from the scatological if you don’t mind.”

“Oh, I don’t mind.”

“Then tell us more about the consumption recommendations you have.”

“Certainly. Here’s another myth I will seek to expose: Three square meals a day. It is a recipe for excessive caloric intake, which will almost certainly lead to weight gain after a certain age, typically around thirty-years old, and unless you have a very physically demanding job or are an elite athlete, which very few of us are, then you do not need three thousand calories a day. Most of us should probably have only two meals a day: One which breaks the fast, and a second that closes the stomach. So, for example, if you eat a traditional morning breakfast, then have a midday meal and skip dinner. Alternatively, wait until Noon or later to break the fast, and then have dinner. Ideally, all calories are consumed within an eight hour period of breaking the fast.”

“That sounds like just another form of intermittent fasting.”

“That’s exactly what it is. Intermittent fasting. If you can complete your consumption in six hours and fast for eighteen a day, that is even better. Some days, perhaps once a week, it is advisable to fast for twenty to twenty-four hours so that your system can recover. You will feel better, and the food you eat when you break the fast will taste surprisingly good, better than it would have if you had not fasted.”

“But if you are smoking as well, aren’t the taste buds affected.”

“Hogwash. Brush your teeth and tongue. The human body is surprisingly resilient. But it does require some modicum of discipline. Govern your own body, and disregard the government's admonitions. That is my advice.”

“Well, I must say, this has certainly been an interesting alternative perspective, Doctor Higglesby. Anything else before we conclude today’s program?”

“Yes, Cameron: Smokers Unite!”