As I wheeled Chris off the elevator, he was quieter than the day before, definitely not in the mood for pranks. He didn’t complain—my husband never complained—yet he clearly wasn’t feeling as well.

Two steps forward, one step back: that still qualified as progress.

Rolling through the hospital hallways, following signs for Radiology, we passed several women wearing nasal cannulas and pulling oxygen-cylinder carts. The sight wasn’t remarkable in that the National Institutes of Health runs clinical trials on virtually every ailment—from the common to the rare, the treatable to the terminal. What was surprising was seeing a cohort of patients similarly afflicted, all female and relatively young.

At least they were ambulatory. When Chris’s doctor ordered a scan this morning, his nurse ordered a wheelchair.

During his first few days after readmission, Chris’s condition fell somewhere between depleted and God-awful depending on the degree of his sawtoothing fever. As his treatments—withdrawal of anti-rejection meds included—began to take effect, however, I’d sometimes arrive to find him sitting up in bed, looking comfortable and alert, like a patient soon to be released.

Towards the end of the week, his humor kicked in. After opening a colleague’s get-well card to find a droll reference to their firm’s new management—a buyout of the Rouse Company was but two weeks away—Chris reached for the bedside phone. When a recording advised him to leave a message, he deepened his voice and pretended to be the CEO. “This is John B—,” he said gruffly. “It’s come to my attention that you have a poor attitude about the merger.”

To me, the spoof was proof of recovery. To his friend, who didn’t recognize Chris in disguise, it was cause to call the head of security: Someone was impersonating the chief executive.

Come Friday, Chris remained frail despite signs of improvement. His nurse took me up on my offer to drive him to his appointment.

In the Radiology waiting room, we found two more women on oxygen therapy. After positioning Chris at the end of a row of seats, I took the one beside him. If silence had been a preference en route, now it was a prescription. No one spoke or made eye contact. No one leafed through magazines, for there were none. No one asked the time or glanced at their watch. It was as if chronic illness had instilled a monkish composure. Or torpor.

I was the only non-patient in the room, the Lucky One. As the others sat alone with their thoughts, I wondered what those might be. That three back-to-back tests followed? That with sick leave exhausted, the boss had to be told? That scrambled eggs might stay down? That last time the shadow had shrunk, so this time, well, don’t get too hopeful?

Or were they trying to avoid thinking, instead imagining doing something—anything—more agreeable? Strolling through the hill town of Assisi. Watching a Coen brothers film. Defending an IRS audit.

One of the women on oxygen finally had enough. Silence wasn’t a chance to grab a shot of mindfulness; silence was a looming endgame. By talking, she could ward off quietus. But she needed a partner.

“What brings you here?” she asked me, in a tone so warm and genuine that she might have been a greeter in a small-town visitors bureau.

She looked about forty, or a little older, but it was hard to tell; illness can age a person faster than a Broadway makeup artist. Although her appearance was middling in every respect—from her height and build to her facial features and shade of brown hair—her spirit was striking. Whether the vivacity was innate or cultivated for survival, she offered me what she desperately needed: a deep breath of fresh air.

“My husband needs an X-ray.” I glanced at Chris. He showed no sign of wanting to engage. Under the circumstances, it felt unfriendly, even hurtful, to not offer more. “He had a kidney transplant a few months ago,” I added. “Now he has mono.”

Immediately, another patient stood and left. Perhaps she went to the restroom, or realized she’d left her purse in the car. More likely, mononucleosis spooked her—even though it’s not an airborne infection.

I paused, realizing that my interlocutor might want to leave, too. She didn’t budge. “How about you?” I asked. In deference to patient privacy, I avoided the politeness of trading names.

“I need a double-lung transplant. There’s a group of us here who have the same disease. We get together every year.” She chuckled. “It’s like a reunion!”

Lymphangioleiomyomatosis, or LAM, is a rare condition that primarily affects women ages twenty to forty. Abnormal cells invade the lungs, as well as lymph nodes and kidneys, leading to reduced pulmonary function and respiratory failure. Treatments, including transplantation, can enhance the quality and duration of life but the disease is incurable. After diagnosis, life expectancy is usually ten to twenty years.[1]

Her disclosure was stunning. Not long ago, I wouldn’t have grasped the challenges she faced, merely to delay the inevitable. No longer.

One day she would lie in an OR, as we recently had. But unlike Chris, whose kidneys were allowed to fail in place, with one of mine nested beneath them, she would have both lungs removed to accommodate her grafts. No matter how damaged and inadequate, those lungs were infusing her blood with oxygen, ridding it of carbon dioxide, maintaining life. Temporarily, she might require a heart-lung machine and a ventilator; ultimately, she’d either breathe though the new air sacs or wouldn’t . . . breathe. If her grafts failed, there was no recourse like dialysis to sustain her.

In short, she would perform a death-defying, net-free launch from a trapeze with no turning back once she let go of the fly bar. Her odds of surviving even five years after transplantation were not much better than one in two.[2]

And that was if she got lucky. With the chronic shortage of deceased-donor organs, lungs might not become available in time. Although living donation was possible, she’d need two Good Samaritans, each providing the lower lobe of a lung.^⁠ They’d face a riskier surgery and longer recovery than kidney donors, which meant friends and relatives were less likely to volunteer.

A radiology assistant called Chris’s name. Together, they disappeared through a door leading to the imaging machines. Moments later, the woman was called, as well.

She’d shared no details about her personal life. She’d only spoken of her illness, which, understandably, had come to define her—from what lung-healthy products she could buy to how she should dress, walk, or perform daily chores, such as unpacking groceries, to minimize exertion. If she seemed compelled to tell me she had LAM, it was not because she sought sympathy; she struck me as someone devoid of self-pity. What she wanted was to be heard. To be heard is to be remembered.

In no time, Chris was back and we were retracing our route through the cold fluorescence of the corridors. As we entered an empty elevator, he said, “You shouldn’t have mentioned I have mono.”

“Why?”

“You saw the woman leave.”

“But she had a right to know. I’d want to know.”

I hadn’t meant to embarrass him. For that I was sorry. But I was as disappointed in him as he was in me. Chris was still “chesting” his health cards, as if this were a hand of bridge, with nothing but his pride at stake.

No doubt a gender difference was at work, a primal XY-chromosome trait, which he’d exhibited many times before: Never show weakness lest a contender seize the advantage—be that your mate, your kill, or your year-end bonus. According to such logic, illness fell between failing and fatal flaw.

A strategy suitable for the savanna or a boardroom, however, is counterproductive in a medical setting where any debility you don’t reveal is one that isn’t treated. The woman I’d just met understood the importance of communication, on every front, regarding her health. I was sorry that my husband didn’t.

And hadn’t.

At the same time, I was grateful. As we made our way back to his room, my mind unspooled a skein of “at leasts.” At least he isn’t suffocating to death. At least he can fall back on dialysis. At least he isn’t alone while undergoing treatment. At least his graft shows no sign of rejection. At least I haven’t had to kiss him goodbye outside an OR and wonder if he would return. At least both of us were able to presume we would return.

Counting blessings was my luxury, not Chris’s. Sick as hell, he was entitled to feel however he felt, unthankful included, with no obligation to parse his advantages relative to others.

Later that night, Chris’s doctor called me at home. He’d had Chris moved to intensive care. He spoke so calmly and matter-of-factly that I didn’t panic. In fact, the thought never occurred to me that every “at least” would soon count for nothing.

[1] National Heart, Lung, and Blood Institute, “Health Topics: LAM,” http://www.nhlbi.nih.gov/health/health-topics/topics/lam (accessed February 1, 2019).

[2] Organ Procurement and Transplantation Network, “National Data: Lung Kaplan-Meier Patient Survival Rates For Transplants Performed, 2008 – 2015; Survival by Single vs. Double Lung (Lung Only),” https://optn.transplant.hrsa.gov/data/view-data-reports/national-data/# (accessed February 2, 2019).

Open heart surgery is performed after putting the patient to sleep under a general anesthetic. The chest is then opened by the surgeon, and the heart is temporarily bypassed or deactivated for the duration of surgery (although in some new techniques like beating heart surgery or minimal invasion heart surgery, the operation is possible without deactivation of the heart) During this period the functions of the heart are performed by an artificial lung mechanism called the heart-lung machine (cardiopulmonary bypass machine). Performing surgery on a working heart cases where there is no facility for beating heart surgery would be like trying to repair the engine of a car while it is in motion. This is why it is necessary to temporarily prevent the functions of the heart during the operation, which requires great care and accuracy.

Stopping the heart

During this procedure the patient is connected to the machine, thin pipes called cannulae are inserted into the main veins which lead to the heart, and thus the blood which goes to the heart is directed into the heart-lung pump, fed with oxygen, and then redirected into the body. Preventing the function of the heart is not a very difficult process. When the heart-lung machine is activated and the blood is cooled and redirected into the blood vessels, the body temperature is reduced to below 30°C, and this lowers the heart rate and assists the heart to stop functioning. The actual stopping of the heart is performed by feeding a serum containing a concentrated solution of potassium ions into the coronary artery, which feeds the heart muscle. Potassium ions are normally found in the human body but in a fixed proportion; potassium is an electrolyte which, if increased, causes a defect in the heart’s rhythm and can lead to ceasing of the heart function. Feeding the coronary artery rapidly with a rich potassium solution causes the heart to stop within a few seconds and allows the surgeon to perform the operation on a non-functioning, motionless heart.

The heart should not be stopped from functioning for a long period, even if the heart-lung pump is performing the function of the heart successfully. Under normal conditions the pump cannot perform the whole duty of the actual heart and lungs. When the body temperature is reduced, there is a reduction of functioning in many organs of the body to such an extent that they almost stop working, especially the brain. This means that every organ freezes and if the patient’s pulse were taken within this period, they would be assessed as dead.

Restarting the heart

To restart the heart following the operation a reversal of the procedure performed at the beginning of surgery is necessary; the temperature of the body is increased to 36.5–37°C again with the help of the heart-lung pump, and at the same time the amount of potassium in the blood is reduced to a normal level. This is usually executed by ensuring the normal function of the kidneys which discard the potassium from the body. This is when the function of the heart is monitored closely because there is a reversal in the process of inducing low body temperature and the excess of potassium which caused the heart to stop. In other words, the barrier which stopped the flowing river is removed; therefore, according to the laws of physics, the trapped fluid should flow again at great speed, and although following surgery the majority of hearts do begin to function again when these procedures are performed, there is unfortunately no actual guarantee. There may be certain complications or even causes which we have not yet discovered, in which case an electric shock of 10–20 joules is delivered directly to the heart muscle to encourage it to function normally. If this is unsuccessful, medication such as adrenalin, which induces the functioning of the heart, is given to the patient. If, following these repeated procedures, there is no effect, and, regardless of all the effort, the heart does not function, then everything is performed again from the beginning, including the operation. But there is always the possibility that the desired result may not be achieved. Human beings always face the prospect of death in daily life, and although there is a very slim chance of death, with such a big operation there is always the possibility.

The result

We are normally totally unaware of the rhythmic incidents, a combination of great harmony, occurring within our bodies. Even breathing, a necessity for every living creature to stay alive, is not an action which we activate and continue of our own will. Sight, hearing, hunger and senses are acts of nature over which we have little direct will or power. Nevertheless, they are all events which we can only describe as divine miracles and what a great blessing it is that none of these complex functions of our bodies have been left to us humans.

It is estimated that 80 to 90 percent of all cancer cases are related to environmental and lifestyle influences (1). Many cancer research centers estimate that 80 to 90 percent of human cancers are preventable. Beside chemicals and infections (viral and parasitic), extrinsic factors include diet among a variety of other factors wholly or partly determined by personal behaviour. Though genetic factors and age affect cancer onset rates, the conclusion holds that many human cancers are avoidable (2). A great number of these are related to tobacco smoking and chewing, alcohol consumption, homosexuality, promiscuity and excessive exposure to solar radiation as in sunbathing, all practices disapproved in traditionally religious societies.

Dr John Hill, a London physician, reported an increase of lip cancer in pipe smokers as long ago as 1761. Sir Percival Pott reported cancer of the scrotum in chimney sweeps in 1777, which he attributed correctly to lodgement of soot in the rugose scrotal skin. This type of cancer was virtually eliminated by simple personal hygiene (3). Later, many chemicals were proved to be carcinogenic and hence many cancers became avoidable by taking more care when dealing with them. Ionizing radiation is still an important hazard, preventable by taking better care.

Tobacco and Cancers

In many countries cancer is the second most important cause of death. In the USA and many developed countries, it accounts for 20 percent of all deaths (1,2). An estimated 6 million new cases of cancer occur annually worldwide, of which about a million are caused by tobacco smoking and chewing (4). The death toll due to malignant disease in the USA amounts to 400-450,000 annually of which 100,000 are due to lung cancer, 85 to 90 percent of those due to cigarette smoking (1,2). Indeed, tobacco (smoked, chewed or sniffed) is the most important single factor in cancer causation generally, responsible for 30- 40 percent of all cancers (5). No other single agent has been examined in more detail, nor more firmly established as a causal agent, than cigarette smoking (6). Let us look at some of the facts.

The risk of cigarette smokers developing lung cancer increases with the number of cigarettes smoked the duration of smoking, the time of onset and the type of smoking. Approximately one-sixth of those who smoke two packs of cigarettes per day will eventually develop lung cancer. The risk to hose who smoke 40 cigarettes per day are 25 times more that to non-smokers (6-8). Cigarette smoking causes all ol the major types of lung cancer including squamous cell carcinoma, adeno carcinoma, oat cell and large cell carcinoma (6). Cancer of the lung was a rare form of cancer at the beginning of this century, even in developed countries. As smoking increased dramatically after World War I among men, and among women after World War II, the incidence of cancer of the lung showed incessant increase until the seventies, after which it began to decline among men and a decade later among women. Nevertheless, cancer of the lung is still the first killing cancer among men and women in many developed and developing countries (7,9,13). In Hong Kong, the rates for women are now the highest in the world (13). Lung cancer rates in Chinese men (e.g. 50.2 per 100.000 in Shanghai) are higher than in many North American and European populations (13). It is the leading cause of cancer mortality among males in Bulgaria. Cuba, Czechoslovakia, Egypt, Greece, Hong Kong. Hungary, Israel, the Philippines, Poland, Romania, Singapore, Thailand, Uruguay and Zimbabwe. The risk is particularly high among cigarette smokers, and a clear cut dose-response relationship has been confirmed. The risk is greater among those who started smoking at a young age and those who smoke high tar cigarettes (2,14-16).

Laryngeal cancer is the second cancer caused by cigarette smoking, but the total number of cases is smaller than lung cancer and the survival is much better (6). Cigarette smokers are five times more likely to develop cancer of the oral cavity and the oesophagus than non-smokers (&-8). There is synergism between alcohol and cigarette smoking in causing cancer of the larynx oesophagus and oral cavity(6-8.14-16,22).

Cigarette smoking is also an important contributing factor in cancers of the bladder, kidney and pancreas. Association between gastric cancer and smoking has also been noted (23-26). Cigarette smoking has even been implicated in cancers affecting the breasts, kidneys, liver, cervix, uteri and many other organs (27-29). It has also been implicated in childhood cancer as a result of prenatal exposure to parental smoking (30). Passive smoking was implicated in causing many cases of cancer (31-33).

Non-smoked Tobacco

Long term use of chewing tobacco or snuff has been linked to cancer of the oral cavity, cheek, gums and oropharynx (6). Oral cancer is one of the ten most common cancers in the world. In Bangladesh, India, Pakistan and Sri Lanka, it is the most common malignant disease and accounts for a third of all cancers. More than 100,000 new cases occur annually in South and South East Asia (13). The commonest cause for oral cancer is tobacco chewing, usually in the form of betel quid which consists of betel vine leaf (piper betel), areca nut, lime and tobacco (13,34). Tobacco chewing is also widespread in parts of Yemen, Sudan and Southern Province of Saudi Arabia: the so called ‘shamma’ is a tobacco plus lime and ash mix, implicated in many cases of oral cancer in these areas (35,36).

Tobacco was propagated in developed countries by tobacco companies after the decline of cigarette smoking there. The 39th World Health Assembly in 1986 adopted Resolution WHA39 which declared that ‘the use of tobacco in all its forms is incompatible with the attainment of health for alt by the year 2000’ (37). The study group concluded that the use of smokeless tobacco caused cancers in humans, the evidence of causality being strongest for cancers of the oral cavity. It also increased the risk of cancers of the nasal cavity, pharynx, larynx, oesophagus, pancreas and urinary tract. Laboratory studies clearly supported the observations that smokeless tobacco caused a number of precancerous oral lesions (37).

Carcinogens in Tobacco Smoke

Tobacco smoke is an aerosol consisting of about 2000 different substances, 50 of which are already proven to be human carcinogens e.g. Benza pyrines, Benza anthracene, Benzo floaranthene, Benzene and other Benzyl derivatives, cadmium, chrysene, methylchryscne, methyl fiouranthene and nitroso compounds (38,39).

Cigarette smoke also contains significant amounts of radioactive substances e.g. thorium Th228, polonium-210 and radium-Rd226. These compounds lodge in the lungs where they constantly irradiate the nearby cells and hence facilitate malignant change (38). Even the urine of cigarette smokers contains mutagenic substances for bacteria, and substances that cause changes in the chromosomes of human cells in tissue culture.

Sidestream smoke which is inhaled by non-smokers contains fifty fold greater concentration of nitrosamines than mainstream smoke. In one hour of breathing in a smoke filled room, a non-smoker may inhale an amount of nitrosamines equivalent to the amount inhaled after having smoked 15 filter cigarettes (38).

Cessation of Smoking

The risk after cessation of smoking decreases dramatically. Light smokers approximate the risk of nonsmokers after 10 to 15 years of cessation of smoking, while heavy smokers have a residual two to three fold increase after cessation (2,6). The mechanism of lung carcinogenesis and smoking cessation has been extensively studied (40).

Women and Smoking

As women started smoking long after men, there is a time lag in the incidence of lung cancer. The incidence of lung cancer has already fallen for men in most developed countries while it was still increasing for women early in the eighties. In 1984, 32 percent of the women smoked in Britain compared with 36 percent of men. In 1961, the figures had been 60 percent of men, and 40 percent of women. Whereas in 1950 the average woman smoker smoked half as many cigarettes as the average male smoker, in the eighties the corresponding figures were 14 and 16 cigarettes (41).

During the second decade of the anti-smoking campaign in Britain, smoking started to fall among women too, slowly at first, but with accelerating momentum (42). Similar trends are found in all developed countries, In some countries e.g. Australia, smoking among young and middle aged women was rising in the early eighties (5,43A4). The proportion of male smokers was falling in 19 out of 22 developed countries, and for women rising or stable in II countries (42-44). In Austria, Germany, Italy, Japan, U.S.S.R., smoking among women was still rising in the early eighties(42).

We may note that lung cancer has already surpassed breast cancer in the number of fatalities it causes. Non-smoking wives of smoking husbands (passive smokers) and non-smoking women working in smoking environments are also afflicted with lung cancer(6,31-33.37).

Trends in Developed and Developing Countries

Anti-smoking campaigns have been launched in the developed countries in the last three decades with tremendous achievements. In Britain, 60 percent of men were smokers in 1961 (the year before the first report of the Royal College of Physicians about smoking was published). By 1971 this figure had dropped to 47 percent, by 1984 to 36 percent, and by 1992 less than 25 percent of the adult males are smoking. As already noted, a similar trend among women smokers was apparent with a ten-year lag (42-45). The decline in cigarette consumption in other European countries and the USA has been comparable. By the mid-eighties sales had plummeted by an impressive 2$ percent with a 5-10 percent annual decline (42-44).

How have the tobacco companies been selling the 10 billion cigarettes they produce daily? By promoting sales in the poor Third World, already suffering from serious health hazards. Consumption of tobacco in Third World has seen a horrendous increase. The World Health Organization (WHO) has reported that tobacco related diseases are on the rise in developing countries.

During the last three decades: in Senegal the percentage of men who smoke in urban areas has reached an unprecedented 80 percent in Bangladesh 70 percent; in Lagos 72 percent of the Faculty of Medicine male students were smoking (46). Statistics from the Chamber of Commerce of Saudi Arabia show an unbelievable increase in tobacco imports: over 4,5 million kgs in 1972: over 27 million kgs in 1977; nearly 36 million kgs in 1981; 42 million kgs in 1984 – an increase of 900 percent (47-48). It is no surprise to find that lung cancer in Saudi Arabia has increased dramatically – from the twelfth most common cancer in a 1950-61 study (49) to the third most common cancer in a 1979-84 study (50). It is expected to be the leading cancer in the nineties us the effects of smoking are unfolding.

The tobacco companies’ methods are unscrupulous as well as aggressive, with bribery of government officials to permit promotion not unusual. In 1982, the head of the Malaysian parliament retired and went to work as a chairman of Rothman’s, Malaysia’s largest cigarette manufacturer (48-51). Ethiopia imported 200 million expensive British cigarettes in 1984 when a large portion of its population were starving to death (52). In Bangladesh, smoking of five cigarettes daily robs the family of a quarter of its food supply, which results in an estimated 18.000 deaths among children annually (53). Unfortunately, the World Bank and Western Governments are co-operating with the seven giant tobacco companies (three American, three British and one French). The World Bank has given Pakistan 60 million dollars in loans to raise tobacco and the US Food for Peace Programs have spent 2 billion dollars in loans to developing countries for the purchase of U.S. tobacco and to establish joint-venture tobacco projects and factories (48-51). Tobacco needs to be cured with heat, obtained by burning wood. This results in deforesting 7 million acres annually with the obvious detrimental impacts on the local ecology, Heavy use (without protective measures) of carcinogenic pesticides on tobacco plantations has also resulted in many fatalities.

Neither tobacco promotion nor high tar content are restricted in many third world countries. Cigarettes smoked in China. India. Pakistan. Sri Lanka the Philippines etc. contain 21-33mg tar and 2-3mg nicotine: while in tile developed countries of U.S.A., Canada, Western Europe, the maximum legally permitted levels are 15 mg tar and 1 mg nicotine (13,46,48).

China consumes one third of the world’s production of cigarettes, while the other developing countries consume another third (48,54). The Eastern and Western block combined consume the remaining third.

The WHO emphasizes the need for a ban on tobacco promotion which should be comprehensive, fully implemented, well publicized, given major priority by governments and health authorities, and sustained on a long term basis (13).

Islamic Law and Tobacco

Muslim muftis and grand ‘ulama’ proscribed smoking tobacco soon after it was introduced to Turkey around 1000H (1573). Sultan Murad of the Ottoman Caliphate made it a capital offence in 1663. The former Grand Mufti of Saudi Arabia, Sheikh Mohammed bin Ibrahim (55) included in his fatwa the names (If many grand ‘ulama’ and muftis who had proscribed tobacco use since its first appearance in Turkey, Morocco, Egypt, Syria, and Yemen (56). All the religious authorities in Saudi Arabia, including of course the present Grand Mufti, Sheikh Abdul Aziz bin Baz, prohibited tobacco use, its promotion, sale, cultivation or dealing with it in any way other than destroying it.

Recently the 1st International Islamic Conference of ulama’ (On Drugs, Narcotics and Liquors held in Madina, March 22-25, 1982, under the auspices of Crown Prince Abdullah bin Abdul Aziz passed a resolution prohibiting the use of tobacco in any of its forms, its cultivation, manufacture, trading in. selling or promoting it in any way (57). The WHO Eastern Mediterranean office published a book in 1988 under the title Al-Hukm al-Shar’i fi at-Tadkhin (Islamic legal ruling on smoking) which involved the decision of the ten leading ‘ulama’ of Egypt, including Sheikh Al-Azhar, who explicitly considered tobacco use as haram (58).

The grounds for these judgments were:

1. Smoking is detrimental to health. The Qur’an states clearly Don’t kill yourselves (4.29) and Make not your own hands contribute to your destruction (2.195). Islamic teachings generally, as well as hundreds of sayings of the Prophet, upon him be peace, encourage Muslims to preserve good health and abstain from things injurious to health.
2. Tobacco use wastes huge sums of money. Saudi Arabia spends annually more than one billion riyals on tobacco imports (59). Some poor Muslim countries spend more money on smoking and other tobacco use than on health promotion or education. The Qur’an deplores such waste: Squander not your wealth senselessly. Squanderers are indeed the like of Satans (17.26, 27).
3. Smoking is had and impure, khabath. The Qur’an declares that the Prophet, upon him be peace, forbids all that is bad and impure and allows all that is good and clean (7.157). Smoking is bad and impure, as it Causes environmental pollution and is unpleasant, even seriously harmful, to those who do not smoke, injuring others is completely prohibited in Islam and considered one of the worst sins a believer can commit.

There is a great need to inform Muslim communities about the legal opinions on tobacco use and the rationale for them. The Muslim governments should stand firmly against the pressures exerted upon them by the tobacco companies and their powerful Western backers. If Muslim countries and peoples adhere to the traditional religious lifestyles. They will succeed in avoiding the perils and tragic losses of life and wealth caused by tobacco consumption.