Smoking habit. From the history to present philosophy of prevention and ethical issues.

12. Is smoking comparable to the effects of other substances such as alcohol, barbiturates, heroin and cocaine?

23. Previous

30. More data... 1 st cause of avoidable death in the world Number of tobacco smoker deaths/year Deaths due to AIDS + Deaths due to malaria + Deaths from childhood diseases avoidable with Vaccines 5 million deaths =

32. Cardiovascular disease Arterial ischemia Vascular disease Nicotine Smoking  Catecholamines  Carboxyhemoglobin Endothelial damage  Cyclooxygenase  Aggregation, adhesion and platelet viscosity  Plasminogen  Alteration of the form of red blood cells  Oxidative stress Proinflammatory state  Oxygen demand  Supply of oxygen to tissues  Thrombus formation  Thrombolysis Atherosclerosis

36. Next Spanish Association against Cancer Tabacco no, thanks How bad fumes? View

40. TYPES OF LUNG CANCER (III)

43. Products of carcinogen metabolism Covalent binding to DNA (irreversible) (directly connected to cigarette number) Optimal cellular repair mechanism over time Non functioning of some repair mechanisms Normal levels of damage DNA mutation HOMEOSTASIS No apoptosis Cellular transformation CANCER * Moreover, reactive oxygen species of smoke Oxidative damage DNA mutation

44. LUNG CANCER PATHOGENESIS p53 gene encodes for p53 protein Cell cycle control DNA synthesis DNA repair Cellular differentiation Gene transcription Programmed cell death Benzopyrene p53 mutation G-to-C and T-to-A transversion (more frequent in smoking women) p53 protein alteration and loss of function * Moreover, p53 gene = tumour suppressor gene Its mutation Oncogene activation Tumor suppressor gene inhibition Synergistic effect on the combination of several mutations Increased risk of developing cancer

50. Who has to establish tobacco's rules? SOCIAL CONSCIENCE (II) To preserve public health THE GOVERMENT AND CIVIL SERVICES To preserve sanitary and medical health PHYSICIANS AND SMOKING TREATMENT AND PREVENTION EXPERTS (CLINICAL ETHICS)

51. CLINICAL ETHICS Difference between apparent freedom of action and truly voluntary decisions The cigarette is lighted by the smoker Apparent voluntary action However, it's not a truly free action but rather a lack of will to refrain from smoking Is the intervention of physicians legitimate? The physician has to advise the cessation of smoking (proposition, not imposition) The main function of the physician here is to educate and instruct rather than to cure. (One of every two smokers dies prematurely)

52. In brief … It's a worldwide public health problem that requires: INTERNATIONAL COOPERATION and SOCIAL CONSCIENCE Smoking habit Sanitary Social Economic Environmental … consequences

53. WEB sites (I)  Tobacco Road: History  Hist ory of t he Indies  Jean Nicot  James I of England  John Hill  Fritz Lickint . The first reports on smoking and lung cancer. Why are they consistently ignored?  Schairer and Schöniger : Lung cancer and tobacco consumption  Richard Doll and Bradford Hill  Final Warsaw Declaration  Framework Convention on Tobacco Control  Nicotine Addiction  Genetic basis of tobacco dependence  Drug Addiction  Smoking and lung cancer