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Some of the hoarseness and vocal distortion you hear in her last recordings could be chalked up to irreversible laryngeal tissue damage from smoking alone

If you want to know why, well, the reason is simple

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Alcohol use and smoking after liver transplantation

Since it takes 20 to 30 or more years to induce the various smoking-related diseases, men began to develop lung cancer, symptomatic COPD, recognized coronary artery disease and so on only after World War II