washingtonpost.com  > Print Edition > Weekly Sections > Health

'What Is Wrong With These People?' Medical Experts Share Their Views

Tuesday, March 29, 2005; Page HE05

What makes a manifestly unhealthy habit so tenacious? Doctors have wondered.

In a 2000 editorial in the American Heart Association journal Circulation ("Cigarette Smoking: How Much Worse Can it Get?"), Robert Califf of the Duke University Medical Center's Division of Cardiology noted the high percentage of American adults who persist in smoking and asked, "What is wrong with these people?"

He offered his own three-part answer. First, he wrote, "people are not good at thinking about probabilities. The immediate gratification of a cigarette weighs much more heavily in a person's consciousness than a nebulous future risk."

Second, he observed, since cigarettes offer immediate gratification, "one could argue that smoking represents a decision to trade off a short-term, self-perceived, improved quality of life for a higher long-term risk of death and disability."

Finally, he noted, smoking's addictive quality means that "youthful indiscretion and daring can become a physical problem reinforced by unalterable physiological urges."

Appreciating the power of those urges took Americans some time.

Conventional wisdom once held that smokers smoked because of social pressures and personal preferences, said Martin Jarvis, professor emeritus of health psychology at University College London's department of epidemiology and public health. The U.S. Surgeon General's Report of 1988 changed that by recognizing nicotine's key role in smokers' behavior. Now that we know nicotine for what it is -- an extraordinarily addictive substance that, when inhaled, finds its way to the brain in seconds and can produce wicked withdrawal symptoms when taken away -- addiction has elbowed out habit and peer pressure as the prime culprit in keeping people smoking.

It's not enough to resolve to quit. According to the American Legacy Foundation, an anti-smoking group established in 1999 with tobacco industry money paid to settle a national class action suit, former smokers make an average eight to 11 attempts before they succeed in quitting permanently.

Yet there are those who resent the implication that their decision to smoke is anything other than a rational choice. Thirty-five-year-old Bill Williams, a computer programmer, said he made a conscious decision to start smoking 10 years ago, when he moved to New York after college. Cigarettes "smelled good," he said, and smoking "seemed like a good thing to do."

"I didn't start because it was habit-forming," Williams said. "The first one wasn't a habit."

Williams founded the Web site www.smokinglobby.com in response to what he considered virulent media efforts to make smokers feel like pariahs. Smokers are a "very nonvocal minority," he said. (The Smoking Lobby doesn't "really do much of anything. . . . I just put the Web site up so people could talk.")

Williams, who smokes a pack a day of Parliament Lights, said he doesn't get the nicotine high he hears others talk about; nor does he rely on cigarettes to relieve stress. As for weight control, he said, "I seem to have no problem putting on pounds whether I'm smoking or not."

"I enjoy smoking," Williams wrote in an e-mail, "and view it as a very relaxing and normal hobby. I completely entered into it as an act of free will."

-- Jennifer Huget


© 2005 The Washington Post Company