Imagine this scene: nearly five hundred years ago, in 1492, tobacco first arrived in Europe. And what's most interesting is that just 70 years later, the respected scholar Nicolas Monardes published a work describing 36 diseases that he believed could be cured by smoking. Migraines, constipation, insomnia—all were proposed to be treated with tobacco. Today, this sounds like cultural absurdity. If someone gave such a presentation now, they would simply be laughed at.

But therein lies a deep and unsettling paradox. It took humanity almost 500 years for the scientific world to recognize, realize, and prove that smoking is incredibly harmful. The first significant reports on the dangers of cigarettes appeared only in the 1950s, and the World Health Organization launched its first major anti-tobacco campaign only in 2003. Think about that: it took 33 years from the moment the harm was scientifically proven to the start of a global fight. Why so long? The answer is simple: a powerful tobacco lobby and societal inertia.

This journey into the past isn't meant to bore you. It's meant to make you understand: we are standing in the same place again. Today, we are offered "safe" alternatives that have appeared very recently. History is repeating itself, only the scenery has changed.

Modern Illusions: A Closer Look

We're told that new smoking devices are harmless, and many believe it. There's a popular experiment where cigarette smoke is passed through cotton, which turns black from tar. Next to it, the same procedure is done with vapor from an electronic cigarette, and the cotton remains white. The conclusion seems obvious: there's no harm. But this is a manipulation. Just because the harm is invisible doesn't mean it doesn't exist. There are simply other harmful substances that don't stain the cotton. And it would be a great shame if it took us another 500 years to realize this.

The Allure of the Hookah: The Myth of Water Purification

Many consider the hookah a harmless pastime because the smoke passes through water and is "purified." This is one of the most common myths.

• Carbon Monoxide: In one hour of smoking a hookah, a person inhales a dose of carbon monoxide equivalent to a pack of cigarettes.
• Tar: Even after water filtration, a single hookah session contains more tar than a pack of cigarettes. The water in the base changes color for a reason—it only traps a fraction of the harmful substances.
• Carcinogens: Hookah smoke contains formaldehyde and acetaldehyde. Formaldehyde is a powerful carcinogen, the same substance used to preserve tissues in anatomy labs.

Electronic Cigarettes: A Toy with Hidden Consequences

The first electronic cigarette was created in 2003 by a Chinese inventor who wanted to help his father, a lung cancer patient, quit smoking. The intention was noble, but the result has been mixed.

On one hand, in the short term, electronic cigarettes are indeed less harmful than tobacco. They contain fewer heavy metals like arsenic, cadmium, or aluminum. But "less" does not mean "zero."

On the other hand, a new disease has emerged, known as EVALI—lung injury associated with vape use. In 2019, thousands of teenagers in the US were hospitalized in serious condition. Their lungs, at 20-25 years old, looked like those of smokers with a 20-year history. This fibrosis that develops in the lungs is irreversible.

The greatest danger of vapes lies in their marketing. They look like harmless gadgets: bright, with pleasant flavors like strawberry or banana. When a teenager smokes a cigarette, it draws criticism. When they "vape," it's seen as innocent fun. This visual safety leads parents to underestimate the harm and even buy these devices for their children, not understanding that they are not toys.

Heated Tobacco Systems: Cooler, But Still a Danger

The principle of heated tobacco systems (HTS) is that the tobacco is not burned (900°C in a cigarette) but heated to 350°C. This releases fewer harmful substances. And that's true. However:

• HTS impair mitochondrial function, which affects cellular respiration.
• They increase oxidative stress and the frequency of respiratory tract infections.
• They increase the risk of microbial penetration into the body.
• Secondhand Smoke: Studies show that the amount of harm a passive smoker receives from HTS is identical to that from regular cigarettes.

The Science of a Vicious Cycle

Why is it so hard to quit? It's not just about the habit of keeping your hands busy. The main mechanism is nicotine. It acts on acetylcholine receptors in the brain, causing the release of dopamine—the pleasure hormone. A simple and strong connection is formed: smoke, get a reward. This is a classic example of operant conditioning, where a behavior (smoking) is reinforced by a positive outcome (pleasure), making the behavior more likely to be repeated.

When a person quits smoking, they crave not so much the nicotine as this "cheap" dopamine. The body remembers the easiest way to get pleasure. That's why this connection is so hard to break. And that's why any stimulants that provide quick pleasure can be addictive.

A View from the Front Lines

Smoking is often associated exclusively with lung cancer. But this is just the tip of the iceberg. Clinical practice shows a grim statistic:

• 90% of patients with bladder cancer are smokers.
• 80% of patients with kidney cancer are smokers.

In all international medical guidelines, smoking is listed as the number one risk factor for these diseases, even ahead of obesity. Seeing people who face the consequences of their choices 15-20 years later is an opportunity to look into the future and understand the true cost of harmful habits.

Breaking Free: Beyond Willpower

Of course, many know that smoking is harmful, just like excessive sugar or alcohol consumption. But sometimes a reminder, backed by facts, helps to hold back at the right moment. Knowing the consequences, understanding how difficult treatment can be, and realizing the example you set for your children—all of this strengthens resolve.

The hardest part is when your entire social circle smokes. But changing habits starts with changing your environment. Instead of meeting friends at a hookah lounge, you can suggest another place. If people respect you, they will understand your choice.

Loving life is not just about enjoying it, but also about taking care of your health so that this enjoyment can last as long as possible. Sometimes the best way to get dopamine is not another puff, but an achievement in sports, a new hobby, or simply time spent with loved ones. The choice is always yours.

References

• Shihadeh, A., Schubert, J., Klaiany, J., El Sabban, M., Luch, A., & Saliba, N. A. (2015). Toxicant content, physical properties and biological activity of waterpipe tobacco smoke and its tobacco-free alternatives. Tobacco Control, 24(Suppl 1), i22–i30.

  This review provides a detailed analysis of hookah smoke composition. The study confirms that despite water filtration, the smoke contains significant amounts of toxic substances, including polycyclic aromatic hydrocarbons, heavy metals, and carbon monoxide, the levels of which often exceed those in cigarette smoke.

• Blount, B. C., Karwowski, M. P., Shields, P. G., et al. (2020). Vitamin E Acetate in Bronchoalveolar-Lavage Fluid Associated with EVALI. The New England Journal of Medicine, 382(8), 697-705.

  This key study by the U.S. Centers for Disease Control and Prevention (CDC) established a link between vitamin E acetate (a common additive in vape liquids) and the 2019 outbreak of lung injury (EVALI). The publication provides biochemical evidence of the harm of vaping.

• Glantz, S. A. (2018). Heated Tobacco Products: The Example of IQOS. Tobacco Control, 27(Suppl 1), s3-s4.

  This editorial in a leading journal examines heated tobacco systems using IQOS as an example. The author argues that although the levels of some toxins are lower than in conventional cigarettes, this does not make them safe. The article emphasizes that they still deliver nicotine and other harmful compounds to the body, and the long-term health consequences are still unknown.