In conjunction with World No Tobacco Day which falls on Saturday, ALLAN KOAY talks to an expert about why smokers should not let their health go up in smoke.
A CHARACTER in a Hollywood movie had an unusual way of giving up cigarettes. He would throw away one stick from a fresh pack of cigarettes, and two sticks from the next pack that he buys, and three from the subsequent one, and so on until he is left with no cigarettes. A novel way of quitting? Maybe, but there are definitely better ways than that.
Clinically, there are two ways of helping a smoker to kick the habit – the pharmacotherapy and non-pharmacotherapy method. The former entails the use of medicine, but according to Dr Mohamad Haniki Nik Mohamed, lecturer in clinical pharmacy at Universiti Sains Malaysia, studies have shown that each method has a different success rate. But the highest success rate is achieved when they are used in combination.
“Smokers are addicted to smoking because of one thing: nicotine, a highly addictive substance,” explained Dr Mohamad Haniki. “And somewhere along the process, cigarette smoking becomes a physiological behaviour. It’s quite complex.”
In Malaysia, nicotine replacement therapy is available and there are 155 Quit Smoking Clinics set up by the Health Ministry nationwide since 1999. The ministry had, in 1991, launched the Healthy Lifestyle initiative that included decreasing tobacco-use initiation and increasing tobacco-use cessation with the ultimate aim of creating a smoke-free nation.
The nicotine replacement therapy available in Malaysia are the nicotine gum, nicotine patch and nicotine inhaler. The gum, which releases nicotine when chewed, comes in 2mg and 4mg pieces, while the patch, which comes in 5mg, 10mg and 15mg doses, is stuck on a hairless part of the body to provide daytime delivery of nicotine. The inhaler is suitable for those who are inclined towards the hand-to-mouth action of smoking.
Nicotine replacement therapy provides a small and controlled amount of nicotine to diminish the craving for cigarettes, decrease the number of cigarettes smoked and reduce symptoms of withdrawal. It also provides “clean” nicotine without the tar, carbon monoxide and other chemicals found in cigarette smoke.
“Nicotine has stimulatory as well as depressive effects,” Dr Haniki elaborated. “So it’s actually part of our normal physiological function; it’s available in our bodies. It’s just that when you increase the intake of nicotine, you stimulate certain centres of the brain that gives pleasure. So, smokers are actually re-tuning these centres, in such a way that they would constantly need more and more to heighten the level of pleasure.”
Another problem is that cigarette smoke does not only contain nicotine but also at least 4,000 other chemicals, and at least 50 of these have been identified as cancer causing. People would mostly think that smokers risk getting only lung cancer, but it has been shown that smoking causes other types such as bladder, stomach and even breast cancer.
Short-term risks of smoking include harm to foetuses, infertility, impotence and exacerbation of asthma. Long-term risks include heart attack and stroke, cancers, chronic obstructive pulmonary diseases and long-term disability.
A closer look at the types of dangerous chemicals contained in cigarette smoke reveals a true horror story. There are substances that are used for making paint, PVC, pesticide, nail polish remover, termite poison, floor cleaner, batteries, mothballs, and even rocket fuel ingredient and the gas used in the death chamber!
“Smokers may not know there are effective medicines to help them quit smoking successfully,” said Dr Haniki.
“So once they know there are different products available, they can choose the ones suitable to them, and there are people who are capable of helping them to quit, who are trained to help them choose the right products, monitor their status, and help them keep away from tobacco for the rest of their lives.”
But Dr Haniki warned that even after quitting for years, there is a danger of relapse, especially if a person gets depressed or is faced with problems. That is why he emphasises the importance of follow-ups by healthcare practitioners and pharmacists to check on the patients.
“Once the patients have quit smoking, they tell me that they can’t even stand the smell of cigarette smoke,” said Dr Haniki. “They hate it so much.”
Dr Haniki also answered some other questions:
Why do people start smoking?
There are so many factors. One is because of role models. Young people see adults smoking, so why not? It must be something that’s okay. Another is the aggressive advertising by the tobacco industry. Now that direct advertising is banned, they have indirect advertising through sponsorship of events. That’s another issue that has to be tackled on a national and international level.
There is the false imagery created by the tobacco industry (the macho cowboy, the sophisticated golfer, the vacationers). To me, I look at those ads and I don’t think of smoking. But if you ask a smoker, when they see a (cigarette company) logo, (it triggers a response). I asked them if they thought of cigarettes, and they said “Yes, of course!”
What about the claims by some people that smoking helps them work better? Is it psychological?
It’s psychological. Nicotine does not increase brain function. On the contrary, nicotine has been shown to decrease the IQ level of children, especially those with parents who smoke.
How do people develop the willingness to quit? Under what circumstances do people go to the Quit Smoking Clinics?
In our clinic, they come mostly because of health reasons. We train our physicians to ask “Do you smoke?” and tie it in with their current diseases. The New England Journal of Medicine showed that 70% of smokers at one time or another actually expressed their willingness to quit. But only one-third of them actually get help because the healthcare practitioners somehow do not play an active role in promoting smoking cessation. I feel strongly that community pharmacists have a very important role. They see the people in their community all the time, so if they just ask, they can advise, assist and arrange follow-ups. Then they are doing an added-value service.
Is there really such a thing as a social smoker who isn’t addicted to smoking?
That is a grey area. It’s something that we as healthcare providers feel that if they smoke only when they are with colleagues or friends, they are not chronically addicted. For addiction, we have the Fagerstrom questionnaire (which is used to determine a smoker’s level of addiction). Their Fagerstrom score may be zero, but they still smoke, maybe when they are golfing or treating friends to lunch. But at home or at work, they don’t smoke. We call it “social” for want of a better term. But until and unless they get to the point where for example, they smoke more than 10 cigarettes a day, or the first thing that they go for even before brushing their teeth is a cigarette, then we know that is addictive behaviour.
Addiction is the craving for something, and if you don’t have it, you cannot function as a normal human being. Smokers are basically nicotine addicts. If they don’t get their fix, they become irritable and get withdrawal symptoms, just like those on heroin and morphine.
Would the danger be the same for a social smoker?
It differs. We always hear this argument all the time: “My grandfather started smoking when he was young, and he lived to a ripe old age. So why should I stop?” If you were a clone of your grandfather, then you would definitely be the same as him.
There are genetic differences, and there are also environmental differences. Your grandfather may have been a blue-collar worker; he may have smoked, but he also lived a “healthy” lifestyle, using energy at work. Whereas you may eat and sit in the office and do nothing much. So the health factor is different. So we cannot really use that argument.
Studies have shown that smokers die prematurely.
Are there statistics on the number of cigarettes smoked per day to indicate the level of danger?
Right now, the consensus is at least 10 cigarettes a day to indicate addiction. Less than 10, there’s probably no addiction, but you also have to look at the Fagerstrom score. Then you can classify the level of dependency on nicotine. The World Health Organisation does not really set what you have to use. The United States guidelines use the number of cigarettes smoked. Other studies have cited the use of Fagerstrom scores.
We always hear differing views about second-hand smoke. Very recently, there was a newspaper report that said second-hand smoke is not dangerous, that it’s a myth. Before this we heard that it is dangerous. And before that we were told it was not. What is the truth?
The truth is that it’s dangerous, and the myth is that it’s not dangerous. It’s as simple as that. At the conference that was held recently in Subang (Selangor), a speaker from Universiti Malaya presented a paper on second-hand smoke myths and facts. She presented a study that showed yes, second-hand smoke is dangerous. And those who say that it is not dangerous are all backed by tobacco companies. So you have to read between the lines and see who is really producing the paper.
If someone wrote something and you don’t know who that person or his affiliation is, then you have to do a little bit of research and dig a little deeper. You can search industry documents available on the Internet or in the archives in Britain. You might find that this person is sponsored in one way or another by a tobacco company. Usually the myths are all from tobacco companies.
One of the concerns among women smokers is that if they quit smoking, they will put on weight.
It is only temporary. Initially, they may enjoy the food (because they can now taste the food better), but in the long run it will not be good for their health. We don’t want them to stop smoking and be fat or obese, because that would invite other diseases. So we want them to keep healthy. They have to involve themselves with proper diet management and exercise programmes.
It is also a myth that you have to smoke to keep trim, a myth portrayed by, again, tobacco companies. They put the word “slim” in the names of their cigarettes just to appeal to women. What is slim about cigarettes? Nothing. It’s probably because when you smoke you fill your stomach with air and smoke, so you don’t eat. Then you get slim. But if you quit, and you don’t eat, you’d still be slim!
Why do manufacturers add all those dangerous chemicals into a cigarette?
A cigarette is a highly innovative product, highly technological. You'd be surprised. You have to read about how they make the paper, the pores, the layers, the filter, the substances. They are all for one reason – to facilitate delivery of nicotine to the brain. Cigarettes are the fastest method of delivering nicotine to the brain.
So in conclusion, it all means that without the awareness about the real dangers of smoking, smokers would not be motivated to quit?
There has to be collaboration among the healthcare sector, the pharmaceutical companies, the Health Ministry and the smokers and non-smokers.
You may think that since there are smoking and non-smoking areas, it means that those sitting in the non-smoking section are safe from second-hand smoke. But the analogy is, it is like having a swimming pool with peeing and no-peeing sections. It makes no difference.
Did you find this article insightful?