Tobacco Use – An Islamic View
by Sheik N. Hassan, M.D.
Dr. Hassan is a Pulmonologist and Associate Professor of Medicine at Howard University, College of Medicine, Washington, D.C.
It has been stated, and Muslims do accept the fact that Islam is a way of life. We are told in the Holy Qur'an:
I have only created Jinn and men that they should serve Me!" [Al Dhariyat/The Wind/51:56]
Literally speaking then, everything we do must be in the way of Allah (s.w.t). This does not mean that we are only to accept the Shahadah, perform the Salaat, give Zakaat, observe the Fast, and perform the Hajj. While it is essential that we accept and practice these "five pillars of Islam," our lives are not limited to them. We must go about our daily lives to properly clothe, feed, and shelter our families and perform other duties as well. We are guided in the Holy Qur'an on this issue:
O ye who believe! When the call is proclaimed to prayer on Friday (The Day of Assembly), hasten earnestly to the remembrance of Allah, and leave off business (and traffic). That is best for you if ye but knew."
And when the prayer is finished, then may ye disperse through the land.... [Al Jumu'ah/The Congregation/62:9-10]
In this connection, we must therefore look at all aspects of our lives. This article examines the health consequences of tobacco use, and also analyzes the implications of it from an Islamic standpoint. The medical information contained herein is factual, and is based on research by leading scientists throughout the world. Details of the illnesses described can be found in any standard textbook of Internal Medicine, or in certain publications from the U.S. Department of Health and Human services. Tobacco is being used in several forms. These are: cigarette smoking, cigar smoking, pipe smoking, chewing and sniffing tobacco. All forms of tobacco use are associated with diseases.
Tobacco has been in use at least since 3500 B.C., and the people of the day thought that its use would heal certain maladies and satisfy hunger. Historically though, there have been numerous campaigns and laws to prohibit consumption of tobacco as surely the people recognized the ill effects of it. These include:
All of the items cited above can be found in the 1988 publication of the U.S. Department of Health and Human Services:- The Health Consequences of Cigarette Smoking: Nicotine Addiction. Since then, the evidence has continued to mount in support of the fact that tobacco use is associated with several diseases, many of which often result in permanent disability and death. This, of course, places a burden not only on the user of tobacco, but also on family members, friends, co-workers and society in general.
Why People Smoke
Smoking is a learned behavior. Many people who smoke begin to do so at a very early age, usually in high school, and some even start in junior high school. This is often the result of peer pressure, of children imitating adults (especially) parents, and of pressure from advertisements where smokers are portrayed as being sexually attractive and powerful people. Smokers then soon begin to associate tobacco use with pleasure and relaxation, and as relief from anxiety, boredom, and fatigue. The individual becomes literally addicted not only to the nicotine, but also to the mere act of "lighting up." In addition to the addiction, this learned behavior is reinforced many times. For example, one who smokes 20 cigarettes per day would have this behavior reinforced more than 7,000 times each year.
Early projection for smokers indicate that these people will die 7-9 years earlier than if they did not smoke. In a more recently concluded study, it was determined that male smokers can expect to die about 18 years earlier than if they did not smoke, or if they had stopped smoking at an early age. The same is true for women smokers.
Cardiovascular: Smokers have a 3-5 times more likelihood of developing coronary artery disease than do non-smokers. In this condition, the small blood vessels which carry blood to the heart muscle itself become blocked. Initially, such individuals develop chest pain particularly or exertion (angina), and frequently such symptoms are ignored. Eventually or even initially, the blockage may be so severe that the person develops a heart attack, which can result in death. Even if death does not occur at that time, the person may become severely disabled for many reasons, including heart failure.
In a similar manner, the blood vessels to the brain can be involved, and when these vessels become occluded, the individual will develop a stroke. The result of the stroke will depend on which vessels are involved, since different vessels supply blood to different parts of the brain. Such patients may therefore develop paralysis on one side or the other, thus resulting in the person being unable to walk, write, feed himself or herself, talk, or even swallow. Some of these patients can become completely bedridden, and therefore depend on others for all aspects of day to day living. Bedsores, pneumonia, and bladder infections then become formidable problems. Some patients may die initially from the strokes, while others succumb to complications. Smokers can also develop blockage of circulation of blood to the legs. When this occurs, the patient will complain of pain or discomfort in the calf of the leg, especially upon walking. Ultimately, ulcerations (sores) on the affected foot can develop, and may require amputation of the involved limb.
Respiratory Diseases: The most common organ which is affected by smoking is the lung. There are several diseases which can result here. The most feared one is lung cancer. It has been shown that someone who smoked 2 packs of cigarettes per day for 20 years has 60-70 times the risk of developing lung cancer than a non-smoker. It has further been demonstrated that about 90% of all lung cancers are seen in smokers. Cancer is the process whereby the normal tissue is replaced by abnormal tissue (cancerous), which multiplies rapidly and can spread to different parts of the body. While some lung cancer can be treated fairly well if found early enough, others result in death in less than one year, despite all modalities of treatment. It is also not uncommon for patients to ignore the early warning signs of lung cancer. Many smokers develop either emphysema or chronic bronchitis, while others may develop both.
Collectively these types of breathing problems are called Chronic Obstructive Pulmonary Diseases (COPD). Chronic cough and sputum production is more common in patients with chronic bronchitis. This can cause sleep fragmentation, disruption in work and other social interactions, and can be particularly annoying to other people around the person. Both result in shortness of breath with limited exercise tolerance. Some patients may even develop heart failure as a result of the lung disease. Therapy is life long and is costly. In some patients, continuous oxygen supplementation is necessary. It is well known that after a certain age, people normally lose a small portion of their breathing capacity, which does not result in impairment of lung function. However, smokers lose this function at a much more rapid rate, and the loss is even more pronounced once the person develops COPD. Naturally, this results in disability.
Other Problems in Smokers: The dose of certain medications, related or not related to diseases caused by smoking, must be carefully administered in all patients, but especially so in smokers. If not, the medicine can be ineffective, or result in toxicity, either because of too little or too much. This is due to the effects of the cigarette smoke on the medication itself. It has been clearly shown that smokers who undergo surgery, for whatever reason, experience more complications following the surgery than do non-smokers. Smokers also experience increased respiratory symptoms when disease cannot otherwise be clearly demonstrated. In addition to lung cancer, cancer of other organs are also seen with increased frequency in tobacco users. These include cancers of the pancreas, kidney, uterine cervix, esophagus, pharynx, larynx, and mouth. The latter are especially the result of the use of smokeless tobacco (chew and snuff), cigar smoking, and pipe smoking.
Passive Smoking: Passive smoking is the term which is applied to non-smokers who innocently inhale the smoke which emanates from the cigarettes and exhaled air of smokers. A common situation is in the home, where little children and others must breathe in the smoke of a smoker who lives in the home. These innocent bystanders do experience increased frequency of pneumonia, bronchitis, and other respiratory tract symptoms when compared to people who live in a smoke-free environment. Evidence is also mounting now to show that these passive smokers are also at an increased risk to develop lung cancer. Passive smoking may also aggravate allergic symptoms, particularly in patients with asthma.
During the past few decades, cigarette manufacturers have lured people to smoke by advertisements, as described earlier. In response to pressures from the medical community, concerned citizens, and governments, manufacturers have been producing filtered tip cigarettes as an accommodating gesture, and as an attempt to reduce the health hazards of tobacco. It should be noted though, that the low tar and nicotine cigarettes do not eliminate the adverse effects of cigarette smoking. It must be borne in mind that, for years, cigarette manufacturers have denied the association between cigarette smoking and lung cancer. In a June 1990 episode of ABC's Nightline, the vice president of a major cigarette company admitted the fact that cigarette smoking is associated with lung cancer. The advertising campaign to promote smoking has been curtailed in the U.S., and so now the manufacturers are targeting other countries to sell their products.
Smokers pose a risk and a burden not only to themselves, but also to society in general. The health hazards of active and passive smoking have already been addressed. The problem goes beyond that. Cigarettes cost money, and it is easy to figure out the cost per year to an individual smoker, simply by multiplying the cost of the cigarettes for one day by 365. While this may not appear to be much for some people, it can go a long way to feed the hungry. Furthermore, when tobacco users (and passive smokers) become ill, the costs mount even higher, as it is expensive to treat the various diseases. While personal health insurance (for those who are covered) may take care of some of these costs, the individual will have to pay a significant portion himself or herself.
One must not lose sight of the fact that insurance premiums for consumers, in general, are based in part on usage by the subscribers. Therefore, if health care costs become less on a national level, then the premiums will not be as high. Tobacco users who become ill also suffer the consequences of being away from the job. Salaries may be reduced, jobs may be lost, and co-workers will have the burden of doing the work of the absent smoker. Illnesses pose a physical and psychological stress on f'amily and friends. These facts arc particularly disturbing when one recognizes that tobacco use is not a necessity, nor is it a luxury, but rather it is a gamble on health itself. Thus, the smoker becomes a burden on his or her family, and on society.
Tobacco users are playing games with their health. The user is taking the chance, or gamble if you will, that he or she will not get any disease associated with tobacco use. The user also neglects the effects of tobacco smoke on others. When illness develops, the person will not be in the best possible position to worship Allah (s.w.t). He or she will be unable to properly perform Salaat, Fast, perform the Hajj, and even pay the Zakaat, which the user could have paid if he oe she were not ill and was fully employed without the expense of health care. Other forms of worship, in the activities of our day to day living, will also be curtailed. This includes the ability to care for oneself and one's family. The extent to which this occurs in anyone's family will depend not only on the severity of the illness, but also on the amount of personal resources one has to buffer the loss. Tobacco use, with or without all the adverse consequences attached to it, can thus be viewed as wasteful spending. In this context we are told in the Holy Qur'an:
O children of Adam! Wear your beautiful apparel at every time and every place of prayer: eat and drink: but waste not by excess, for Allah loveth not the wasters. [Al A'Raf/The Heights/7:31]
In considering this, we must realize that the Holy Qur'an is for guidance in all aspects of our lives. Islam lays great stress upon hygiene and health. We can view the physical body as a gift from Allah (s.w.t); it is a gift for the temporary residence of the soul in this world. So, just as one would care for a gift from a loved one, one should also take even better care of the gift from Allah (s.w.t), as our love for Him should be even greater. This would permit us to be in better health, so that we can better serve Him. There are numerous verses in the Holy Qur'an which enjoin healthy habits on mankind. Some of them include:
O ye who believe! When ye prepare for prayer, wash your faces and your hands (and arms) to the elbows; rub your heads (with water); and (wash) your feet to the ankles. If ye are in a state of ceremonial impurity, bathe your whole body... [Al Ma'idah/The Table/5:6]
It is He who sendeth down rain from the skies; with it We produce vegetation of all kinds: From some We produce green (crops), out of which We produce grain, heaped up (at harvest); out of the date palms and its sheets (or spathes) come clusters of dates hanging low and near: And then there are gardens of grapes, and olives, and pomegranates, each similar (in kind) yet different (in variety): When they begin to bear fruit, feast your eyes with the fruit and the ripeness there of. Behold! In these things there are signs for people who believe. [Al An'Am/The Cattle/6:99]
Certain things are clearly prohibited in Islam. There arc several verses in the Holy Qur'an in which these are outlined. The following is one of them:
Forbidden to you (for food) are: dead meat, blood, the flesh of swine, and that on which hath been invoked the name of other than Allah; that which hath been killed by strangling, or by a violent blow, or by a headlong fall, or by being gored to death; that which hath been (partly) eaten by a wild animal; unless ye are able to slaughter it (in due form); and that which is sacrificed on stone (alters). Forbidden also is the division (of meat) by raffling with arrows: that is impiety... But if any is forced by hunger, with no inclination to transgression, Allah is indeed Oft Forgiving, Most Merciful. [Al Ma'idah/The Table/5:31]
Closer examination of Holy Qur'an shows that we are commanded not only to take what is lawful (avoiding the things which a mentioned above) but also what is good.
O ye people! Eat of what is on the earth, lawful and good;... [Al Baqarah/The Cow/2:168]
Eat of the things which Allah hath provided for you, lawful and good; but fear Allah, in Whom ye believe. [Al Ma'idah/The Table/5:88]
On the basis of these facts then, we should avoid those things which are unlawful, and those things which are not good. In other words, we must also avoid those things which are harmful to us from religious, spiritual, and physical standpoints; and certainly tobacco use is one of them.
Benefits of Cessation of Tobacco Use
In 1976, a research paper was published which clearly demonstrated that those smokers who elect to stop smoking derive tremendous benefits. If the abstention is long enough, coughing will subside, lung function rate loss will normalize, and chances of developing diseases associated with tobacco use will be significantly reduced. The earlier the cessation, the more likely one will be able to reduce or even eliminate the increased risk of disease. The authors also demonstrated a significant decline in annual death rate from lung diseases, including lung cancer and other forms of cancer as well; providing the individual stopped smoking early enough, and resists future temptations. Even for those patients who have already developed disease, reduction in severity and progression of illness will be noted. Good physical health promotes good mental health, the result being an individual who is responsible to himself, his family, society, and Allah (s.w.t). He or she therefore engages in continuous worship of Allah (s.w.t) in all aspects of life.
The best remedy for a disease is to not have it. Thus, the best therapy for tobacco-associated diseases is to avoid tobacco use. We must therefore practice self-restraint. For someone who is already smoking, or using other forms of tobacco, he or she must stop immediately. Frequently, the individual will need professional help to accomplish this, but he or she must be motivated and take the first step. Allah (s.w.t) tells us in the Holy Qur'an:
...Because Allah will never change the Grace which He hath bestowed on a people until they change what is in their (own) souls. [Al Anfal/The Spoils/8:53]
Those who develop symptoms of disease should seek professional help early, so that the disease can be identified and therapy (which includes cessation of smoking) can be instituted early. We must remember the hadith:
The Prophet (s.a.a.w) said: "There is no disease that Allah has created, except that He has created its treatment. [Al Bukhari; Vol. 7, #582]
If you do not smoke, but know of someone who does, then you should encourage that person to stop smoking (or using tobacco), as there will be physical and spiritual benefits for both.
All forms of tobacco use are detrimental to our physical, mental, and spiritual health. It also affects our families, society, and innocent bystanders. The good news is that all of the ill effects can be avoided by abstention or cessation. Even for those who already have disease, there are benefits. Let us work together to prevent diseases which can be prevented. Do not use tobacco and encourage others to abstain as well. Good example is the best da'wah. In Islam, we are encouraged to do good deeds and to spread (teach) good news, as these are also forms of worship of Allah (s.w.t).
Posted November 23, 1998. This article was printed in two parts in the August and September 1993 issues of the Voice of Islam newsletter. (This newsletter is published by the Islamic Society of the Washington Area).