Committed to Quit Tobacco


 Committed to Quit Tobacco
Lt. Gen. (Retd) Mahmud Ahmed Akhtar
Former Surgeon General, Pakistan Army

Pakistan has serious problem of tobacco addiction. Pakistan is one of the fifteen high tobacco smoking country in the world –is the highest in this region. Bhutan has totally banned all sorts of tobacco products. Tobacco has nicotine and thousands of other chemicals. The other chemicals are more harmful. Tobacco products including cigarette, oral, sniffing etc cause fatal pulmonary, cardiovascular disorders and multi-organ carcinomas.

Lt. Gen. (R) Mahmud Ahmad Akhtar

The economic cost of tobacco induced diseases in Pakistan 2021, released by PIDE records that total costs attributable to all smoking related diseases and deaths in Pakistan for 2019 are Rs 615.07 billion. The revenue accrued is a fraction of the cost. The poor people are having food insecurity due to spending their scarce income on nicotine products. On the occasion of this year’s world ‘’ NO TOBACCO DAY” (which falls on May 31st) under the banner theme was the quit has message for smokers,” (commit to Quit.” It says that nicotine found in tobacco in highly addictive, creates dependence .In addition the behavioral and emotional it’s in tobacco use, like craving tobacco, feeling of sadness or stress – makes it hard to kick the habit. With professional support and cessation services tobacco users double their chances of quitting successfully.

In Pakistan instead of smoker (surveys that 70 percent wanting to quit) the commitment has to come from the Government of Pakistan to provide so far non- existent ‘’cessation services ‘’to the smokers. But how? There is an international debate among the health care and scientific community regarding use of vaping as a cessation aid. The WHO says” the scientific evidence on e- cigarette as cessation aids is inconclusive and there is a lack of clarity as to whether these products have any role to play in smoking cessation. However, based on multiple clinical trials – the gold standard in scientific research – many countries have started adopting vaping or HRPS (harm reducing products) along with WHO approved NRT (nicotine replacement therapy) such as nicotine patches and nicotine gum and nicotine lozenges) which are medically approved and widely used to help smokers quit by quelling their nicotine craving.

In contrast to NRTS, currently marketed e-cigarette are not medicines.They are consumer products that offer a convenient, effective and safer way of replacing nicotine that would otherwise be obtained bysmoking. A clinical trial by large New Zealand vamping population funded by the health research council in 2019., suggested that hundreds of thousands of more smokers worldwide successfully quit the killer habitif they used nicotine containing e-cigarette (vapes) together with nicotine patches. A major UK clinical trial published in 2019 that people who used e cigarette to quit smoking were twice as likely to succeed as people who used other nicotine replacement products. The Royal Collegeof Physician RCPS UK recently released their UK report Smoking and health 2021. A coming age for Tobacco control. This comes after 60 years.They issued World’s first authoritative report on smoking and health.

The RCPS estimate that. Of the harm reduction policies, they advocated in 1962,smoking would have ended by now in UK. The new report calls for doctors to play a more active role in helping their patients who smoke. The RCPS report “says we argue that responsibility for treating smokers lies with the clinician who sees them”. That our NHS should be delivering default,ofit out to all smokers’ systematic interventions at the point of service contact.

The RCP also recommended that the UK Government invests in media campaign to urge smokers to switch from tobacco e- cigarette which are less harmful.Governmentsand Doctors worldwide should heed their advice. The Pakistan Governmentmedical institutions should heed to the advice – take active measures as suggested by the RCPS. While nicotine is the addictive substance in cigarette. The UK, NHS website says ‘’ it is relatively much less harmful, almost all of the harms comes from thousands of others chemicals present in the tobacco smoke.

In Sweden sins moistpowdered tobacco has become a popular cessation aid. While many countries mainly developed have adopted vaping as a cessation aid within the ambit of FCTC, many developing countries have banned e- cigarettes.

Pakistan ministry of health science and regulations of coordination (NHRCS) of ratified the FCTC (framework) convention on tobacco control) 16 years ago but only added NRT as a part of the essential drug list in 2018. Sadly, the essential drug list system has not been implemented so far. Pakistan has the distinction of only middle - low income country in the world, of not implementing the list in the world. The WHO has issued 21st list in 2019. Every country in this region is implementing the list since many decades now. This is all due to corrupt practices, elite capture – the corruption virus prevalent every where the poor governance. This is one of the main reasons for Pakistan having the highest mortality rates from fetal loss, Mother, neonatal, child, adult’s mortality and thePakistan -shortest life span. One keeps on seeing statements from the ministry of health and the incompetent DRAP statements off and on introducing genetic drug system. It is quite simple to buy essential medicines in the public sector health institutions and deregister the irrational harmful drugs which are robbing the health of the people and meager financial resources of the public and of the debt-ridden nation. Though NRTS are included in the WHO essential drug list as life saving drugs but these are not available in the Government institutions, are available in the private sector at high price beyond the reach of the common people. Instead of spending huge amount on the cancer hospitals and treating cancers like lung etc. which consume enormous amount of money, it is logical to spend less and prevent the diseases. It is better to not only allow first cancer cell to develop or eradicate rather spending enormous amount to kill last cells which consume too much money and provide poor results. There is a need of paradigm shift.

Even through after on imported vaping paying 30 percent duty have penetrated the high middle-income urban centers but when asked by the WHO, in a classic ostrich approach. the NHRCS reported it has no data on these innovative products, neither it was provided later on. It is an example of the working of NHSC in Pakistan. It adversely reflects on policies and priorities of our state.
The WHO differentiate between HRTS and HRPS calling the latter novel and emerging tobacco and nicotine products including heated tobacco products (HTPS) electronic nicotine delivery system (ENDS) electric non – nicotine delivery system (ENNDS) and other products.

In 2000 the WHO asked the parties of the FCTC to also report on the use of novel and the emerging tobacco products saying that monitoring ENDS among adults and adolescents in essential to understand the level of use and current use of ENDS in 2013 and 42 countries have now nationally representative data available . However the WHO says that the indicator is not yet collected in enough countries to estimate the global level of use.

The tobacco in HTDS maybe in especially designed cigarettes (real sticks or neo sticks) or pods or plugs. HTPS differ from conventional cigarettes and ENDS some of which are called e- cigarette as ENDS do not contain tobacco but rather a nicotine solution. However, the WHO notes that his boundaries between the different products are becoming increasingly difficult to define, given the emergence of so-calledhybrid tobacco products containing both nicotine solution andtobacco.

Pakistan needs to provide cessation services to around 15 millions of its adult population which smoke. The report discusses the economic cost of tobacco induced diseases in Pakistan 2021; released by PIDE records that the total costs attributable to all smoking –released diseases and deaths in Pakistan. for 2019 are Rs 615.07 billion which is 3.55 times higher than the overall tax revenue from the tobacco industry (190 billion in 2019) PIDE estimate.

And poor households are more affected. A study of the social policy and development centre Karachi says that the basic food is that most commonly affected by use in lower income households in having serious problem of malnutrition of children suffering from wasting, stunting etc. 40 percent children are suffering from stunting affecting their physical and mental cognitive faculties jeopardizing their future and of the nation. It adversely affectsthe economy of the country. The recent massive inflation has further exacerbated the already bad situation. Moreover, the low-income families devoted more of their budget to tobacco as compared to wealthy households. In the patriarchy society the male spends money preferring the addictive tobacco products. Abdul Satar Edhi once said that even many poor who come to me for aid, have a cigarette pack in their pockets.

Nadeem Iqbal a free – lance columnist has suggested that Pakistan can save this economic cost by exercising its sovereign right to decide that since the country has not the resources to extend cost effective NRT to people who smoke, it may wantto look info readily available HRPS as cessationaid.

Pakistan is devastated with communicable and non- communicable diseases. Tobacco addiction has further added to the burden of diseases, economic and food insecurity for the poor strata of the population. In addition to preventive tobacco measures there is a dire need to have tobacco cessation measures. Tobacco ranksmajor hazardous culprit.

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