Efforts in advocating the harmfulness of tobacco has not reduced the number of smokers globally. To commemorate World No Tobacco Day on May 31, we ask can there be an end to nicotine addiction?

BY: Dr Tan Kok Kuan

Nicotine in the form of chewing and inhaling smoke from combusting tobacco leaves has been used recreationally, ceremonially and medicinally by humans for more than 2,000 years.  It started in the Americas; Native Americans used to carry tobacco around in pouches even using it as a form of currency to trade with. It was used in pipe ceremonies and even as a poultice to treat wounds.

Fast forward to the 14th century when Christopher Columbus discovered the New World and tobacco quickly found its way to Europe.

Jean Nicot, a French ambassador was credited with bringing tobacco to France and a botanist named the most commonly cultivated tobacco plant after him – the Nicotiana Tabacum – and subsequently nicotine, the active substance, was named after the plant that also carries his name.

In 1509, John Rolfe became the first English colonist to successfully cultivate nicotine in America. In 1880, James Bonsack invented the automatic cigarette rolling machine.This along with the industrial revolution made rolled cigarettes cheaply available to the masses. Of course, at the time no one knew of the evils of smoking.

In fact, cigarettes were thought to be even medicinal. Cigarettes were sold at the hospital bedside to patients. And of course, there was the now infamous “more doctors smoke camels” advertisement where medical doctors were advertising for cigarette companies. Cigarettes were said to be good for pregnant women and were even said to prolong life. You can never smoke too much and it was even a cure for bad throats.

Then in the 1950s, things started to fall apart with the sentinel study by Hammond and Horn that linked cigarettes to cancer. Now we know smoking cigarettes increase not only the risk of cancer but also of heart attacks, strokes and a host of other diseases.

Countries and health authorities started to enact legislation to limit smoking. Big tobacco companies pushed back with intensive lobbying and buying science. They also introduced light and low tar cigarettes and continued to market the lie that these cigarettes were less harmful ostensibly for their own profit motive. Ever since then there has been a tug of war between big tobacco companies, governments and the World Health Organization (WHO) with every increasing animosity much of which is captured in the infamous Framework Convention for Tobacco Control (FCTC).

There are currently an estimated 1.1 billion people in the world who smoke tobacco. About 15 billion cigarettes are sold every single day. Smoking kills seven million people a year, or about 13 people every minute. The time you have taken to read this article, almost a 100 people would have died from tobacco-related diseases. That is a 100 children orphaned, a 100 women widowed, a 100 pairs of mourning parents. Think about it.

These numbers are simply staggering. And this is in spite of intense efforts by government and health authorities to control the smoking epidemic including tobacco excise taxes, graphic health warnings, ad bans, age restrictions, plain packaging and recently I heard that in some countries, even movies with smoking scenes are being banned or at least given an age restriction.

There is a massive nicotine addiction epidemic in the world right now. The vast majority of people are feeding this addiction by smoking cigarettes. Cigarettes cause them to develop cancer, heart attacks, strokes and other vascular diseases. This presents a massive health burden on not only the individual but also the community.

In an ideal world, we want to be rid of nicotine-dependence. Or if we cannot, we want to be at least rid of tobacco. This so called “tobacco endgame” is neither new nor unprecedented. Both Bhutan and Turkmenistan have banned the sale of cigarettes.

In 2010, a team from Singapore’s National Cancer Centre lead by Dr Deborah Khoo published a paper with a bold idea. And that was to ban tobacco sales to individuals born after the year 2000, effectively phasing in a total ban on tobacco. Multiple other tobacco endgame strategies have been proposed ranging from regulating the nicotine level in cigarettes to a smokers’ licensing scheme, to advantaging cleaner nicotine products over combustibles and of course, a combination of various strategies.

I believe the enigma we have to solve is why people choose to smoke in spite of knowing the harm that it causes them and the people around them. And why do governments allow the unmitigated retail sale of cigarettes in spite of the fact that cigarettes contribute nothing to society other than to harm and kill. It has been well-established that good counselling and support are key to helping smokers quit. So, on this World No Tobacco day, let’s all take a minute of our day to point at least one smoker we know on the road to quitting tobacco by visiting their general practitioner or joining the I Quit programme run by the Health Promotion Board.

 

Dr Tan Kok Kuan is a resident doctor at DTAP Clinic Novena.

 

(** PHOTO CREDIT: Mathew Macquarrie, Unsplash)

 

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