Today is World No Tobacco Day :

Medical professionals speak on no tobacco role

by Manjari Peiris

Dr. Lakshmi C. Somatunga, Director/Non Communicable Diseases, Ministry of Health:

Health professionals should play a key role on tobacco control. Especially, medical doctors are in a position to take a prominent role, capable in using their influence in the community to encourage tobacco free societies.

Most of all it is proven that even a brief counseling by a medical professional on the dangers of smoking and the importance of quitting is one of the most cost-effective methods of reducing smoking.

The theme of the World Health Organisation this year is very appropriate because it emphasizes the role of Health Professionals in Tobacco Control. It should be emphasized that the involvement and the leadership of the governmental health sector will contribute to the development of sustainable tobacco control programmes. All health professional organisations should support and take a partnership to make tobacco control programmes more comprehensive.

Tobacco control should be considered as a duty of health professionals, as it is the most preventable cause of deaths in the world.

Dr. Neil Fernando - Consultant Psychiatrist at Angoda Mental Hospital:

Cigarette smoking was widely regarded as a social habit for years; there was little awareness that it delivers psychoactive drug.

Nicotine is a stimulant, which users say calms them down and sedates. Smoking is often viewed as a form of self-medication to cope with stress, but there is little evidence that nicotine possesses any anti-depressant properties.

Smoking is strongly associated with mood states and mental disorders. Past decade has seen considerable progress in understanding the neuro-chemical basis of nicotine's effects on the brain. With this developed new interventions to promote cessation, worldwide prevalence and deaths (one in every two persistent smokers) from tobacco continues to increase.

Deaths from smoking show a time lag of about 30 to 40 years from the onset of regular smoking. The estimated smoking related deaths of 3 million worldwide, is projected to increase to 10 million per year by about 2025. Majority of them will be in the developing world.

Cigarette smoking is essentially a form of addiction to nicotine; it is not solely based on pharmacological factors. Advertising and promotions effectively target young people with images of smoking as trendy, sporty and successful young people from deprived backgrounds where smoking is the norm are more likely to become smokers.

Smoking is linked with poor school performance, low aspiration for future success and school dropouts.

Adolescent smoking is frequently associated with other behavioural problems including alcohol and other drug use; other health risk behaviours or rebellious behaviours. It is also associated with low self-esteem, anxiety and depression.

In adults, smoking is associated with socio-economic disadvantages and stressful life. High rates of smoking are seen among the unemployed, lonely parents, people who are divorced or separated, the homeless, heavy drinkers, drug users and prisoners. Cigarette smoking is strongly associated with mental disorders.

It is also associated with poor psychological well-being. Smoking is more prevalent in the poorest strata of the community. A medical professional should ask a patient about his smoking status at every visit, document it, advise all smokers to quit, in a clear, strong and personalized manner that it is the most important thing he can do to protect his health and tie illness or impact on children and family.

If willing to quit, provide assistance or refer to a specialist, if unwilling provide with motivational interventions. Inform family and friends and prepare environment for quit attempts (discard cigarettes) and to anticipate challenges. Congratulate success, use lapses for constructive learning and elicit recommitment to total abstinence and identify problems.

Professor A. H. Sherifdeen, Consultant Surgeon/ President of Sri Lanka Medical Association:

Various trials and medical investigations have proved that main problem related diseases are cancer, chronic bronchitis in the lungs and problems in the arteries.

If the blood does not go to any particular structure, that structure or the organ tissue will die and the arteries can get narrowed or blocked. Blockages in the arteries to the heart cause heart attacks in myocardium or blocks in the arteries to the brain which causes strokes or paralysis.

Although I am the President of SLMA, my main interest as a surgeon is in the problems in the vascular surgery and my specialty is surgery in the arteries. Why we need surgeries is that poor blood circulation through arteries to the legs and arms causes initially pain, later ulcers and eventually ganglion.

After ganglion, amputation has to be done. About 25% - 30% of artificial legs given away by the Colombo Penguin Society are to the people who have undergone amputation due to ganglion. There are a lot of several risk factors for ganglion and the chief among them is smoking.

We have been telling patients to stop smoking when ganglion is about to start. And they had stopped smoking when they see people with normal legs. Smoking is directly related to many other diseases. It should be classified as a dangerous drug and be discouraged at all levels.

The sad factor of life is that the more we discourage and try to ban, the younger people try to take it. Youth as we all know enjoy living risk behaviour and taking risks. So the more we tell them that it is risky, the more they try to indulge in it because, as far as we know there is no immediate after effects.

The effects are seen in their middle or later life, during which time they are very important people in the society and family. Their children may be pretty young, 10 years, 8 years, old children whom they need a father to look after, but suddenly they lose their fathers at 40-45 years due to a massive heart attack or due to a stroke or paralysis; they will find that their father is disabled because of amputation of legs due to ganglion.

Owing to advertising and powerful market forces these youth find it difficult to give it up. Once they do carry on, then the effects will be seen later.

So this really has the importance of being aware. The society must be aware of the ill effects of smoking and awareness will be the solution. The more we spread this message in schools among children, the less opportunities to recruit into this habit. Tobacco companies are not too concerned about elders giving up smoking; they have limited lifespan because of all the ill effects of smoking and the damages already been done.

The industry will then make every effort to recruit youngsters through advertising and using all inducements. This is a drug to which they get dependent; depending on any form of drug is dangerous, so they should be totally discouraged.

Dr. Mira Aghi, a Behavioural Scientist/Researcher from Delhi, India:

I think the most important thing a medical professional may do towards tobacco control would be if he/she asks the question whenever a patient comes "Do you smoke?"

It will give an instantaneous impression on the patient that his illness is related to tobacco. They should also advice their patients to stay away from smoking. It is excellent if doctors address the children to prevent them from being caught to the habit of smoking.

It will make a lasting impression on them; they would really stay away from the menace of tobacco.

Sri Lanka too has ratified the convention of the FCTC. By ratifying the convention the policy makers really have committed to look after whatever the obligations of the FCTC. We know that tobacco companies are putting much pressure on policy makers giving them money and all kinds of temptations which makes very difficult for them to not to stoop to these temptations. But I think if they are responsible members of the government, they must see that no tobacco advertisements or promotions are sponsored by the tobacco industry. These obligations should be looked into.

Students reading for their medical degrees should be given with an extensive knowledge about the hazards of smoking. My message to the children in Sri Lanka would be to stay away from tobacco because it is very dangerous and unhealthy. We want the children to grow up to their full potential. The only way to do it is to stay away from the ills of smoking.

Dr. Kuma Weerasekera - Oncologist - President of GMOA:

As medical professionals we should talk at least for 2 minutes with a patient about the harm of smoking. If we adhere to this principle, we may resolve this problem to a greater extent. We all know the hazards of smoking; it is hard to correct an addicted smoker.

What is important is to prevent the potential users from getting into the habit. When a child gets into the habit it is difficult to get rid of the practice. However much we explain and try to convince of the consequences, the attempt will not be fruitful. If we explain this to children when they are 10 years, we may minimize the problem. Therefore we should launch preventive programmes in schools through the coordination of school medical inspectors, school medical officers and MOHs.

In Sri Lanka, tobacco consumption is more in rural areas than in urban areas. In 1980 the percentage of tobacco related cancers was 45% and it is now decreased to 23%. This reduction is not from the rural areas, but from urban areas. Therefore we should focus our preventive measures into the rural areas. Nowadays tobacco is promoted and marketed in rural areas to get them addicted to the habit in wholesome.

As medical professionals we should protest against such canvassing done by tobacco industry. Especially we should address female labourers in tea estates who have moved from villages. They are one of the target groups of the industry. Through tabloid papers smoking is being glamourized among females depicting pictures of smoking actresses.

This happens through electronic media at a large-scale, through films and tele dramas. When these women see such portrayals they mis-think that smoking is the solution to overcome distress and that "we should take up this example". FTZ women are another major risk group.

In Sri Lanka the warning message on cigarette packets does not notably display whereas in other countries the content of tar, nicotine, etc., are indicated very well so that the brand of cigarette has a small portion. There is no use of introducing "light tobacco" as nicotine is already absorbed in the bodies of those who have already got addicted to smoking.

We have planned cancer control programmes to address potential users, viz., exhibitions. Also we advice existing users to delay the time that they start smoking in a particular day, for instance, we advice the person who starts smoking at 8.00 a.m. to delay it till 9.00 a.m. on the first day and keep on delaying from hour to hour, every day.

This method helps them to eventually quit the habit. If we advice them to quit immediately, they will feel uncomfortable due to the absorption of nicotine in their blood. It may motivate him to re-start. The best method is to reduce gradually.

I recollect an incident that happened in Gampaha, where young girls had promoted smoking near a school. At that moment the people around had chased these women away.

This is how we should react to promotions. Also still we find that tobacco sponsorships are being offered. To combat such strategies government sponsored awareness should be given to the risk groups.In 1989 there were cigarette promotions via Marlboro racing cars in USA. What the government did was banning of promotions. This helped to reduce the trend of cancer patients remarkably!

Professor Jerry Jayasekera - Surgeon:

My view is that to reduce tobacco consumption we should enhance the wisdom of people. Increasing awareness alone will not be adequate. Smoking is not for those who want to live a long and happy life. The probability that a long-term smoker will eventually be killed by tobacco is 1 in 2.

Advertising portrays smoking as glamourous and healthy. The reality is different. Smoking makes the breath stink and stains teeth and fingers a yellowish-brown. In men it contributes to impotence. It causes smoker's cough and shortness of breath. Smokers are also more likely to experience premature facial wrinkling and other skin problems.

Smoking hurts others. Until recent times a smoker could light up just about anywhere and expect no obligation. But attitudes are changing because more people understand the dangers of breathing in smoke that drifts from the cigarettes of others.

A nonsmoker who is married to a smoker has a 30% greater risk of developing lung cancer than if he or she were married to a nonsmoker. Children who live with parents who smoke are more likely to develop pneumonia or bronchitis in the first two years of life than are children who live in homes where no one smokes.

Think about what else you could do with the money that you spend for cigarettes!

Dr. D. P. Athukorale, Consultant Cardiologist:

Passive smoking has same effects as direct smoking. When I was working in the Cardiology Unit, a young woman had a heart attack; we did all the tests, everything was normal, but noticed that husband smokes in the presence of the wife. We asked this lady how many cigarettes that her husband smokes. He smokes about 40 cigarettes at home and this lady had got a heart attack due to passive smoking. Children get asthma, pneumonia and other diseases due to passive smoking.

Medical professionals should pressurize the administrators to ban smoking at all public places. I suggest that the prices of cigarettes be increased so that a less number will be able to smoke.

It's the price of cigarettes that determines children from buying cigarettes. In Sri Lanka we still see cigarette promotions through electronic media, especially through tele dramas and films. I invite Sri Lankan children to influence their smoking fathers to stop the habit. Also in schools there should be awareness on prevention of smoking and separate lessons as a part of their curriculum. Smoking should be discouraged at the level of school.