COMMENTARY

For John Mellencamp and Other Smokers

Melissa Walton-Shirley, MD

Disclosures

June 30, 2017

It was the summer of '82 when I fell in love with the music of John Cougar Mellencamp. My acceptance to med school prompted a brisk drive on I-65 south with the windows down and the radio blaring. The now legendary riff of the hit "Jack & Diane" with an intermittent clap of the hands leapt from the console of "the big banana," my 1972 LaSabre Buick. Its wailing speakers could transport me from anxious medical student to the status of imaginary rock star with a turn of a knob. That day, it did its magic again.

"A little ditty 'bout Jack and Diane. Two American kids growin' up in the heartland . . . "

"Oh my gosh, who is this?" I later asked my fiancé (now husband) Tony Shirley, who has always been a wealth of music trivia. "John Cougar Mellencamp and he's from Seymour, Indiana," he replied. The state of Indiana was just across the river from our home in Louisville, KY; we felt a connection to the singer.

Med school at the University of Louisville kept me so busy that for a time, I didn't even know what John Cougar Mellencamp looked like. I didn't know that he considered himself a painter first and a combination musician/singer/songwriter second. I didn't know then that in the 1990s Tony and I would have the privilege of seeing him perform as John Mellencamp (no Cougar) at the Nashville Starwood Amphitheater or that I would glance stage right and my heart would sink when I saw the fire-red glow from a burning cigarette slowly elevate to his lips deliberately and methodically between sets.

He had already developed coronary artery disease and suffered a heart attack, while continuing to struggle with nicotine addiction. I would never understand his choices or why the personal business of a human being I would never meet could generate such concern. For some odd reason it still does.

The Mature Rock Star

The years have passed. Tony and I took a road trip this month. To pass the time, I grabbed scores of reading material from pharmacy magazine racks and vulnerable coffee tables of family members—anything with an interesting cover. In one of those publications[1] I spotted a great photo of this maturing superstar, his head cocked slightly to his left, eyes downcast and steel gray hair haphazardly reaching for some unknown skyward destination. He exuded cool. And dangling from his mouth was the demon cigarette once again, an imminent threat to his longevity held tightly.

That cigarette might as well have been a dagger. I read with hurried enthusiasm that Mellencamp was born with spina bifida, was raised by his grandmother, continues to paint, and then the paragraph that is the mantra of so many smokers that really broke my heart.

"I lift weights and I run, but my exercise is not about vanity. I work out because I smoke. If I'm going to afford myself the luxury of smoking, I'd better do something to offset it," he said.

Does he really think he can offset his risk of death from heart attack, cancer, COPD, and stroke by exercising? Does he know that smoking just one to 10 cigarettes per day increases his mortality by as much as 85%?[2] Does he not understand that at this very moment his intracoronary clot-buster levels are probably those of a 90-year-old man? How will he play a guitar or paint with one arm if he has a stroke? How will he sing with no vocal chords if he develops cancer? How will his family deal with his preventable sudden death if he develops a critical blockage? How on earth does he justify taking the chance of leaving this world and silencing his enormous talent over the love of a burning weed?

I wondered if he has seen his cardiologist since the Bio-RESORT trial publication.[3] That Dutch study showed that silent diabetes affects whether your stent stays open or not. Has he had a 2-hour GTT? I vented to my nonmedical spouse, as I twisted the entire point of this joyous article into an impending death announcement.

The Path to Quitting: Plead and Educate

My husband knows that my obsession with helping smokers quit isn't limited to celebrities. Any and every smoker is fair game. Tony was a victim of my successful attempts as well as many family members, friends, neighbors, and the occasional stranger (not withstanding every single patient who walks through my door).

I simultaneously plead and educate because it works. I don't just "tell patients to quit." I explain the pathophysiology, paint a Technicolor picture of their family's lives without them, and give them the tools to quit. I'm not naïve. I watched the David Letterman interview from April 2015 where Mellencamp said,

"I'm gonna keep smoking and I'm good at it. I've written a couple of good songs. I'm kind of good on stage and I have a good first kiss. Other than that, I'm not worth a s—t. I'm useless."[4]

Well, Mr Mellencamp, you aren't useless, but the low self-esteem you harbor is where your addiction flourishes. I've seen that attitude in Kentucky men who ask to be buried clutching a pack of Marlboro Lights in their caskets. It's a macabre last request they think is cute when on this side of the dirt but it's not so cute for family members sitting on the front row at their eulogy where the me, me, me and the I, I, I of addiction speaks the loudest.

And that's the point. Any patient with bad habits surely has more to say, more to do, and more to give. Case in point, Mr Mellencamp at age 65 just released an album to critical acclaim in April of this year. It is precisely why I educate with the Mediterranean diet, preach the gospel of a healthy BMI, rail against sedentary lifestyle, and emphasize compliance until my vocal chords are sore every workday, explaining, explaining.

I will keep doing it because the frustration of a 1000 failures is negated by a single success. I also persist because I know Mellencamp and others like him don't really want to die early. Most just need a combination of nicotine patches and lozenges or varenicline (Chantix) therapy. In my experience, these treatments trump all others for smoking cessation and if given a chance, one of the two systems will work for most. I just know something could work for him.

Then, I continued reading.

"I intend to make my ending good," Mellencamp said. "I'm hoping it's one of those long, lingering deathbed conversations. A lot of people go, 'Oh, I hope I just die quick.' Not me. I need time to put things right," he concluded in the last paragraph of the article.

This is for Mr Mellencamp and all smokers: Quitting smoking is the very best bet to have more "time to put things right." Please don't let your time run out too soon and leave us wanting more.

And please, don't ever let it be said that those of us who care stopped trying.

Editor's note: An earlier version of this post stated that Mellencamp underwent a bypass surgery and received a stent, which could not be verified. Medscape regrets the error.

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