World Heart Day should strengthen the resolve of doctors to engage more with patients by way of advocacy: Prof. (Dr.) M. Wali

Sep 29,2023

Shahid Akhter, editor, ETHealthworld, spoke to Prof. (Dr.) M. Wali, a Padma Shri Awardee and Senior Consultant at Sir Ganga Ram Hospital who had the honour of working with three Indian Presidents. Dr. Wali discusses the impact of COVID-19, evolution of smoking-related health issues, and the advancements in effective tobacco harm reduction techniques.

We must consider that post-COVID, we have observed an increase. Obesity rates are on the rise, stress is causing more people to smoke, there is a lack of sleep, and many individuals are experiencing post-COVID health issues. Healthcare providers are gearing up to address these challenges as we recognize the urgent need to upgrade our systems. When it comes to evaluating the younger population, they represent the future of India, and we must tackle their issues. Counseling sessions and addressing dietary concerns become crucial. All of these factors make our responsibilities more complex. It is apt to discuss these modalities on World Heart Day.

Smoking and stress are global concerns, with European countries and the United States leading the way in harm reduction strategies. We recently had a guest from Israel, Dr. Reuven Zimlichman, who highlighted and shared new strategies that the USA, Norway, Sweden, and other European nations are adopting. They have successfully modified tobacco. This is particularly exciting for young people who need to break free from the habit of hookah and cigarettes. For them, vaping seemed like the only alternative. However, apart from vaping, they now have two promising options.

One of these alternatives is heated tobacco, which has been well-received in European countries, including Norway and Sweden. Most importantly, they have developed a form of tobacco that can be placed behind the lip, similar to a tea bag. It delivers the effect of nicotine with significantly reduced harm, ranging from 20 to 80 percent. This is known as SNUS and represents an exciting development in modified tobacco for harm reduction in relation to tobacco and smoking. It has shown very promising results, and I hope it becomes a viable substitute for cigarettes. About a decade ago, I was part of a project that involved low-tar and low-nicotine cigarettes, which was later taken over by ITC.

We used to have thin or slim cigarettes in the past, but recent innovations in producing tobacco with 50 percent less harm, especially researched by the ICMR in India, are topics for future discussions. Excitingly, the ICMR has introduced a form of tobacco with a 50 percent harm reduction. However, if one doubles the quantity of smoking, it negates the benefit. So, quitting smoking remains the best approach, although these reduced-harm options, like slim cigarettes or low-tar cigarettes, offer a better alternative. It's important to remember that cigarettes, while primarily containing nicotine, also contain nearly 4930 toxic ingredients that are detrimental to the brain, nerves, heart, and lungs. Cigarettes are poison; they bring death.

Some pharmacological or pharmaceutical measures that gained popularity in the past include nicotine gum and patches. While fashionable, people tended to misuse them. For instance, nicotine gum supplies 4 milligrams, leading people to chew it excessively. Nicotine patches are available, but their use is restricted to prescription. These are not the ideal methods for quitting smoking. The actual modalities involve rewiring the brain, learning harm reduction strategies, and quitting cold turkey. The government is also taking steps in this direction by increasing taxes on cigarettes. However, the effectiveness of these measures remains uncertain. Nevertheless, better alternatives are emerging. Until then, we must strive to quit smoking. Smoking is an addiction that symbols alone cannot weaken or eradicate.

Source: HealthWorld