Photos from Wikipedia

Text by Henrylito D. Tacio

Quitting smoking is easier said than done.

A 2019 study on smoking incidence that surveyed 1,500 Filipino regular smokers showed 98% of these people wanted to kick the habit. An earlier study done by the World Health Organization (WHO) said only four percent are able to do so successfully.

Another study showed that 72% of those who surveyed wanted to stop smoking at some point in their life, and nearly 45% indicated that they had tried to stop smoking within the last year. Of the 72% who wanted to quit smoking at some point, only about 18% said that they wanted to stop smoking now.

Smoking is a vice hard to stop. Latest records released by the Philippine Statistics Authority (PSA) and the Department of Health (DOH) revealed only about 640,000 – out of the 15.9 million smokers – were able to quit smoking altogether. This “despite the government regulations on tobacco products to arrest its harmful impact on public health.”

Recent data showed about 110,000 Filipinos die from tobacco-related diseases each year. About 21.8% of male deaths and 9.9% of female deaths are caused by tobacco smoke (18.6% overall). More than 23% of male deaths and 12% of female deaths are caused by tobacco (16.6% overall).

Tobacco use is the cause of several cardiovascular and respiratory ailments, the Makati Medical Center (MMC) points out. Most of all, tobacco smoking is heavily linked to lung damage and cancer.

“Smoking leads to complications in different parts of the body,” MMC explains. “It increases the risk for pancreatic cancer, stomach cancer, and throat cancer, among other types of cancer. In addition, smoking is detrimental to the circulatory system, reproductive system, dental health, vision, and skin.”

Despite these effects, Filipino smokers have difficulty quitting. To think, 75% of smokers (three out of four) want to quit the habit, former health secretary Paulyn Jean Rosell-Ubial reported.

But they cannot do so, particularly the recalcitrant smokers or those who have an obstinately uncooperative attitude towards smoking cessation. What is alarming is that most of them are already having some health problems.

When the coronavirus disease 2019 (COVID-19) entered the scenario, the problem became even more complicated. That’s according to Dr. Rafael R. Castillo, a cardiologist with the Manila Doctors’ Hospital.

“Most of our recalcitrant smokers have smoking histories of more than 20 pack years, and already have mild to moderate chronic obstructive pulmonary disease (COPD), which is a major risk factor for developing severe COVID-19,” Dr. Castillo said.

In the beginning, these recalcitrant smokers may follow the smoking-cessation programs they are told, “but there is an utter lack of perseverance and will to persist until the end goal of complete smoking cessation is achieved.”

All measures known were implemented by doctors to these recalcitrant smokers in order for them to quit smoking. The measures include persuasion, motivation, and even combining them with threats on the health hazards they are likely to develop if they do not stop smoking. “At best, we are only successful in around three out of 10 cases,” Dr. Castillo said.

In exasperation, the doctors decided to implement a policy that “if they do not quit smoking in six months, we advise them to go to another clinic for their subsequent follow-ups, as we consider ourselves a failure in effectively addressing a major risk factor that they have.”

Despite this harsh policy, most of the recalcitrant smokers still fail to completely quit smoking. “The pandemic has made us rethink our policy, and explore other means of assisting those who simply could not give up their nicotine addiction,” Dr. Castillo said.

In their quest for tobacco alternatives, they settled for heated tobacco products (HTPs). In a paper that was published in Cardiology and Cardiovascular Medicine, Dr. Castillo considered HTPs as “a pragmatic middle ground for recalcitrant smokers.”

In fact, Dr. Castillo and his research team conducted a study at the time when the country was experiencing the COVID-19 pandemic (from December 2019 to March 2020). It was done by the FAME Leaders Academy, a research group aiming that those local scholarly studies get published in prestigious international journals.

Earlier research done in another country had a total of 1,726 patients included in the study. Results of the study showed that pre-existing COPD was associated with a four-fold increased risk of developing severe COVID-19. Another finding indicated that active smoking increases the risk of developing severe COVID-19 by around two folds.

With this background, the doctors introduced HTPs to help recalcitrant smokers. “Most smokers are simply helpless against the nicotine addiction; and the nicotine dependence has led to a pattern of heavy smoking despite its known health hazards, which is resistant to change,” observed Dr. Castillo.

As of October 2019, HTPs are being sold in at least 49 countries, including the Philippines.

HTPs are tobacco products that require the use of an electronic device to heat a cigarette or pod of compressed tobacco. The cigarette or tobacco pod is heated to a temperature high enough to produce an inhalable aerosol, but the temperature is below that which is required for full combustion.

“The inhaled substance still contains nicotine (from the heated tobacco), which makes it still addictive,” Dr. Castillo said. “Based on some studies, the amount of toxic substances a smoker gets is up to 95 percent less, compared to traditional tobacco smoking.”

But their main goal is still to make them quit smoking permanently. “From a non-negotiable policy, we have decided to shift to whatever pragmatic middle-ground we could find for recalcitrant smokers; since at least half of these smokers, or more than half in the pre-COVID era, simply could not quit,” Dr. Castillo explained.

With current data, it looks evident that HTPs are likely less harmful than traditional smoking, but are still more harmful than not smoking. “This has to be thoroughly discussed with an open mind by not only the medical or scientific community, but the legislators and regulators as well,” Dr. Castillo urged. “After all, the lives of tens of millions of recalcitrant smokers may depend on the options we offer them if they really cannot quit smoking.”

According to Dr. Castillo, “smokers may be rightfully considered as victims of an addictive disease, and those who cannot quit remain part of the health equation of every nation, just as much as the healthy non-smokers. They actually need more understanding, more attention, and more care from their physicians, who should aim for a treatment goal of at least partially protecting them from the cardiovascular and other health hazards of cigarette addiction.”

The team however doesn’t recommend HTPs to adolescents and non-smokers. “HTPs are better alternatives to cigarettes but not completely risk-free so minors should not use them,” concurred Dave M. Gomez, communications director of PMFTC Inc., an affiliate of the Philip Morris International, Inc.

The core of the matter is nicotine, which is highly addictive. “(Nicotine) causes you to crave a smoke and suffer withdrawal symptoms if you ignore the craving,” said Dr. Michael Joseph Blaha, director of clinical research at the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, in a statement.

Since nicotine is a toxic substance, there is where legislation and regulation come in. “It is essential to have a strict but balanced regulation,” Dr. Castillo and his team said. “Strict control measures must be put in place to prohibit sales of HTPs to nonsmokers and youth.”

As for current smokers, they “must be given free choice to shift to it, if they wish to, and especially with the guidance of their physician,” Dr. Castillo suggested.

Although HTPs are smoke-free, Dr. Castillo believed they should not be allowed in public. “Although the harmful particulate pollution they cause is relatively less compared to passive cigarette smoking, the potential harm to secondhand smoke could not be completely discounted,” he said. – #

(This feature article has also appeared at the print edition of Luzonwide News Correspondent’s December 18-24 (Vol. XI No. 30),2021)