World No Tobacco Day 2018: No more breaking hearts

"I wish we could do something useful with tobacco – like making fertilizer out of it." This was said decades ago by Dr Paul Dudley White, the father of American Cardiology.

Today, closer to home in India, tobacco is killing 2,700 people per day -- a truth that cannot be easily puffed out.

"Even as we celebrate 'World No Tobacco Day' on May 31, the irony is that in the next 24 hours, 2,739 people will lose their lives due to tobacco," points out Dr S Venkatesh, senior interventional cardiologist, Fortis Hospitals, Bannerghatta Road.

The World Health Organization has come out with the theme ‘Tobacco and Heart Disease’ this year. They warn that tobacco use and exposure to second-hand smoke are “major causes” of cardiovascular disease.

Unfortunately, consumption of tobacco is clearly no less than an epidemic. "Tobacco use is classified as ‘disease’ under International Classification of Diseases. This is because the quit rates are very low,– only about three per cent in India. With such a low probability of quitting and such a high probability of tobacco use leading to a multitude of diseases, the prevalence of tobacco has been rightly termed as the Tobacco Epidemic," explains Dr Venkatesh, who is also the patron of the 'Voice of Tobacco Victims'.

He adds, “Tobacco is the known single-most preventable cause of cardiovascular death and disability in the world. Chemicals like nicotine are constrictive in nature leading to coronary problems. It is commonly known that smoking increases the risk of heart disease, but the fact is that smokeless forms of tobacco are equally harmful.”

As per Global Adult Tobacco Survey (GATS-2) 2016-17, in Karnataka, consumption of smokeless tobacco is far more than smoked tobacco. The data shows 35.2 per cent of men, 10.3 per cent of women and 22.8 per cent of all adults (age:15 plus) either smoke tobacco and/or use smokeless tobacco. Smokeless tobacco users are 16.3 per cent, which is far more than 8.8 per cent who smoke tobacco in Karnataka.

There are plenty of concerns and they are only growing by the day. Dr (Prof) US Vishal Rao, head neck surgical oncologist and robotic surgeon, lists some of these worries. "One of the concerns that came out through the GATS survey this March is the doubling of the number of women smokers and increase in cardiovascular and other diseases. In Karnataka, 20,000 more smokers have been added. This is disheartening," he says.

"Meanwhile, tobacco sellers are using it as a strategy to increase the sale of their products. What we are trying to do is clamp down violations of smoking rules in bars, hotels and cafes. It is a violation of the right to life," he says.

"Some of these places are currently not following the rules. Where there is smoking, no service of food and beverages -- even water -- should be allowed. Certain hotels, bars and cafes have randomly marked areas as smoking zones. They should remember that allowing smoking will affect your workers and managers apart from the customers," he avers.

"We have discussed this with different hotel associations. But citizens too need to rise up and bring it up when they see rules against smoking being flouted," he adds.

According to Sanjay Seth, Trustee Sambandh Health Foundation, tobacco use is estimated to cause nearly about 10 per cent of all cardiovascular (CV) disease. Given the large burden of CV disease in India, the impact of this is huge. While governments are budgeting large outlays for setting up healthcare facilities, there should be a greater focus on prevention strategies, chief among them being the reduction of tobacco usage," he says.

Are you also aware of the fact that smokeless tobacco is a major cause of heart disease? "The general perception about smokeless or chewing tobacco is that it is safer than cigarettes and 'bidis' as it does not cause heart disease, but according to experts, tobacco consumed in any form is injurious to health. Using tobacco whether in the form of smoking or chewing causes cancer, heart diseases and other severe ailments," points out Dr Venkatesh.

Tobacco consumption, in any form, does not spare any of the body parts from its harmful effects. "Even smokeless tobacco causes similar ill effects in direct or indirect forms. Apart from causing direct damage to the vessels of our body, it causes significantly increased mortality after the heart attack, in people consuming smokeless tobacco,” informs Dr Pankaj Chaturvedi, Professor Surgical Oncology, Tata Memorial Hospital, Mumbai.

Dr Sudarshan Ballal, chairman, Manipal Hospitals, echoes a million thoughts when he says, "the planet should be tobacco free. I am an anti-tobacco person." He adds, "Any form of tobacco and any quantity of tobacco is bad for you. Staying next to a smoker is equally harmful."

"It is not that you are damaging yourself but you are bringing damage to a lot of other people around you, especially young children and pregnant women. You are in fact hurting the next generation," he says. "Stringent action should be taken against those smoking in public places. There is also a need to create awareness. I would say that the warnings on cigarette packs have not helped as much as they should have," he says.

"A good thing that the government has done is not make tobacco available in public places. As for the smokers, intensive counselling and de-addiction are required. That, along with punitive measures against those violating smoking rules, should be the way forward," he avers.