“Smoking causes knee and hip injuries? Those “scientists” have been working overtime!”
First, let me say that I believe people have the right to smoke, if they wish, and to hurt themselves in this manner, if they wish. It’s a choice, and I don’t believe in the ‘nanny state’.
That said, it’s very important for people to understand that smoking has ‘systemic’ effects on the body that go well beyond tar in your lungs and nicotine’s pharmacological effects. Smoking causes systemic vascular inflammation and oxidative stress, increases the likelihood of platelet activation and thrombosis, activates specific gene expression pathways (e.g. induction of hypoxia-responsive pathways because of carbon monoxide), activates elastase in the lung and promotes mucous gland hypertrophy and increased mucous production - thus contributing to emphysema and chronic bronchitis, and is clearly epidemiologically linked to an array of malignancies - including malignancies of ‘remote’ organs one might not think susceptible, such as bladder cancer.
None of the above is conjecture. It is what it is. So, in the context of the hip and knee issues, it is not a stretch at all to relate smoking to decreased blood flow to the femoral head, which has a precarious blood supply to begin with - (think of Bo Jackson’s football injury which disrupted blood flow to the femoral head and resulted in necrosis of the femoral head and the requirement for hip replacement). It is likewise not a stretch to believe that smoking could decrease blood flow to knee ligaments, and/or result in the activation of inflammatory pathways that could contribute to the degradation of cartilage and tendons.
I could go on and on about the science, and the effects of smoking.
Personal choice, should remain that way, but is a bad choice.
This is most likely true. Old people who smoke often look like their are going to fall to pieces at the slightest touch. And then there are others who are older yet compete in Ironman.
Here is the issue I have with your analysis—and that of much of medicine.
It is based on statistics—that is the overall effect on large populations.
However, within those populations the affects vary widely (perhaps on something like a normal curve).
With centralized decision-making on who gets help and who doesn’t the bureaucrat will always rely on statistics—since they have no easy way to determine who fits where on the normal curve.
So, from the point of view of the state smokers are bad risks—and that drives policy.
From the point of view of the individual (and whether they should get medical care) the state policy is madness.