Hazards of tobacco

Smoking is extremely dangerous to health. It leads to many diseases, shortens life and hastens death. There is now a vast amount of statistical evidence available showing smoking of tobacco, especially of cigarettes as the main cause of great risk in mortality of cancer of lungs, mouth, stomach, bladder, heart diseases as well as chronic bronchitis and emphysema. Over 30 retrospective as well as a large number of prospective studies conducted in Canada, USA, UK, and many other developed countries have proved convincing evidence of its association with the diseases mentioned above.
Mortality risk from lung cancer among cigarette smokers compared to non-smokers has been shown as seven times for those smoking 10 cigarettes, 13 times for those smoking 20 cigarettes and 25 times for those smoking 30 cigarettes a day. Deep inhalers and those who start smoking before the age of 15 years have a higher attack rate. Lung cancer risk is somewhat decreased but certainly remains there by switching over to filter tipped cigarettes or pipe, cigar or hooka smoking. These prospective studies have also revealed that a smoker of 20 cigarettes a day may live five years less than he might have done as a non-smoker.
The relative risk of dying from cancer among smokers as compared to non-smokers has been found to be 11 times in cancer of lung, five times in cancer of mouth and larynx and three times in cancer of oesophagus and stomach. It is significant that lung cancer risk decreases in those who stop smoking. It is halved in those who had stopped smoking for one to five years but after 10-13 years cessation of smoking that risk approximates that of individual who never smoked.
Whereas the mortality from Ischaemic heart disease among non-smokers is 166 per 100,000 populations; its risk amongst smokers increases proportionately according to the tobacco smoked. Among smokers upto 10 cigarettes a day it is 278 per 100,000 population, with 20 cigarettes a day it is 358 per 100,000 population and with 30 cigarettes a day it rises to 427 per 100,000 population. Overall of the total deaths caused by Cancer - 90 per cent are amongst smokers. Deaths caused by Bronchitis and Emphysema - 75 per cent are amongst smokers; and in Heart diseases including coronary artery disease - 25 per cent are amongst smokers.
Newborn babies exposed to parents' smoke develop bronchitis and pneumonia more often and are hospitalised twice compared to those whose parents do not smoke. With parents smoking the risk factor to babies and children are increased with acute respiratory infection; adverse development of lung respiratory function and to fetus in pregnant women.
The ingredients of tobacco/cigarette injurious to health amount to more than 300 compounds. Most important of compounds are nicotine, tar, benzopyrene, nitrosamine, polonium 210 and naphthylamine. Carbon monoxide released from tobacco smoking mixes up with haemoglobin of blood, displaces oxygen and thus causes heart diseases because of less supply of blood to the heart.
Nicotine constricts the blood vessels, cuts down blood and oxygen and thus causes angina and coronary artery disease. It also increases heart rate and blood pressure. Nicotine increases stickiness of blood platelets, thus causing peripheral vascular disease (Buerger's disease). Nicotine also increases mobility of bowel, affects food transit and thus increases gastric acid secretions resulting into peptic and ultimately cancer.
Tar harms the delicate lung tissue leading to cancer. Carbon monoxide dissolves in blood/hemoglobin passing through lung, results in less oxygen - hence cardiovascular diseases. Tobacco when chewed it is a cause of cancer of mouth and upper digestive tract; when taken as snuff tobacco causes nose cancer.
It may be mentioned that the trend in cigarette consumption decreases by one per cent per year in developed countries whereas it is on the increase by two per cent per yew in developing countries.
One cigarette smoked shortens life by 11 minutes; 20 cigarettes a day shortens life by 5 years. Tobacco kills 3 million people each year. Non-smoking wives of husbands who smoke have shown a higher rate of lung cancer compared with wives of non-smokers. Smoking may also cause prolonged ill health. Smokers may suffer from heart attacks like angina and coronary artery disease. Other illnesses include peptic ulcer and peripheral artery disease (Buerger's Disease). Smokers of 20 cigarettes a day have twice as many days off on account of ill health as non-smokers.
Tobacco kills three million people each year around the world, most of them in the productive middle age. It is matter of great concern that the number of smokers is on the increase now in the Third World, including Pakistan, in the wake of widespread anti-smoking campaigns in the industrialized nations compelling tobacco manufacturing firms to shift their promotional focus. No wonder these companies are sponsoring sports events in our countries. While these programmes cause suffering and disease in poor countries, the profits accruing from them are transferred to these concerns that belong to the developed countries.
Not only the smoker's life is at risk but those of passive smokers as well. New born, who open their eyes in the lap of smokers, suffer twice with acute bronchitis and pneumonia in the first year of their life compared with babies of non-smokers.
Now most medical authorities and all governments acknowledge the hazards of tobacco consumption and also the fact that tobacco is the greatest preventable cause of death and disease. In practice, there is a 'smoke ring' of political and economic interests protecting the multinational tobacco companies. This triangular 'ring' comprises the government, which earns revenue, the consumer, who innocently enjoys smoking and spends money to the benefit of the manufacturer, and the mass media, which earns advertising revenue.
The health benefits of smoking cessation are increase in life expectancy, reduces cancer and coronary artery disease and also reduces respiratory symptoms. In addition it reduces risk of low birth weight of babies whose mothers stop smoking in first 3 months of pregnancy.
In Pakistan tobacco sold per year is 108,000 tonnes and number of cigarettes sold per year are 40,000 millions and the Government earns revenue of about 20 billion rupees. The rate of smoking among males is 40 per cent and in female it is 7 per cent.
Passive smoking: There are two streams of cigarette smoking. The main-stream (at 900c) affects the smokers and the side-stream (at 600c) affects the non-smoker (passive smoker) sitting around. This side-stream emits Nicotine, Carbon Monoxide, Ammonia and Benzopyrene, which are found in greater concentration in this side-stream and affect the non-smoker (ie, passive smoker).
According to the statistics released in developed countries - annual death rate from tobacco - related diseases has been estimated at 400,000 in USA, 150,000 in Germany; 100,000 in UK; 90,000 in Italy; 50,000 in France; 30,000 in Canada and 23,000 in Australia. Passive smoking related annual deaths have been reported as 5,000 deaths in USA; 1,000 deaths in UK and 500 deaths in Canada. The above deaths are in spite of all precautions, including ban on advertisements, in the developed world. You can imagine the deaths occurring in our country without any precautions.
It is worth mentioning, for the interest of readers, that Pakistan Chest Foundation instituted a Constitutional Writ Petition in Lahore High Court and ultimately succeeded in obtaining a verdict from the court in issuing a directive to Federal Government to issue an Ordinance and implement its enforcement within 3 months for the prohibition of smoking and protection of Non-smokers Health Ordinance, putting a complete ban on the advertisements of tobacco on radio and television.
It may be understood that governments cannot make this a successful treaty without the help of the people. Organised civil societies must work in this respect to educate people about the hazards of tobacco and at the same time the government should monitor the behaviour of the tobacco industry, which will always try to undo the good affect and working of the treaty. It is time the authorities encourage other viable alternate crops. The government should find other sources of revenue to compensate for the duty now being charged on cigarettes. Smoking is a man-made epidemic and, left unchecked, would continue to cause untold suffering and premature deaths.
The writer is Chairman, Pakistan Chest Foundation and former Professor of Tuberculosis and Chest diseases