By Dr Anil Grover

A signboard on "No Smoking" is like a flashing red light on road junction, you are supposed to stop look and go. You do that if a cop is watching, otherwise you move on. That is what some of us do despite the statutory warnings about ill effects of smoking! The endeavor of this is to at least stop and look before moving on, on the issue of smoking.

"Smoking is bad for you" is oft repeated a mere rhetoric slogan. Going beyond that, let us see country which is like ours but better in keeping health stats, United Kingdom; smoking kills about 1,15,000 people a year and deaths are directly attributable to smoking related cancers, smoking related cardiovascular disease and smoking related lung disease(other than cancer).

Adjusting for longitivity in the Great Britain and population in India still we will have to multiply this figure many a time to get some sense of what is happening in India. The belief, propagated by companies (and perhaps rightly supported by purists of scientific community) that sell tobacco products was that you will have to take lungs of a healthy primate, find out a way to keep it alive, paint it daily with smoke for a dozen years and if it develops cancer that would establish cause and effect relationship. Before that please do no blame smoking. Like all good or bad things in life, you may cite convenient exceptions to the rule: herein some of those smokers who could not kick the habit till they were aged nineties before they kicked the bucket, long after their well meaning family physicians have left the world.

Not any more! In late nineties, judges of the United States were increasingly getting convinced about ill effects of smoking and liability of tobacco companies a $28 billion seemed to settle the issue. Almost simultaneously came the scientific evidence.

What are the most damaging products in a cigarette or bidi?

Tar, a carcinogen (substance that causes cancer)

Nicotine is addictive and increases cholesterol levels in your body.

Carbon monoxide reduces oxygen in the body. (Therefore less blood and less oxygenated too!) Components of the gas and particulate phases cause chronic obstructive pulmonary disease (COPD).

Are the number of cigarettes or bidis smoked are linked to the damage?

Medical scientists differ from one another in determining the number of minutes reduced in one’s life span per cigarette smoked from 5 to 11 minutes (rather a costly way of reducing one’s life span).

However, there is consensus as far as quantifying the amount of smoke over the years it is defined in pack years that is number of cigarettes consumed per day x number of years one has smoked. Most of the damages caused by smoking are related to pack years. It is important to remember that not all the effect occur in every one. Some definite percentage of people escape altogether, leaving them to preach other to continue smoking.!

How long it takes to become ex-smoker (when one is free from all the effects related to past smoking)?

Interestingly, cardiologists consider any one who has not smoked for last one year shall be considered ex-smoker for the simple reason most of the effects are mediated through endothelial dysfunction which recovers completely by one year. However, pulmonologists are more stubborn, it takes one and half decade or more to be free from the smoking linked lung cancer (responsible for 90% all pulmonary cancers). All, other effects recover between these two wide ranges! The logic behind reason that it takes years is this delayed decrease that decline in smoking rates among male population of the United States which took place in 1950s showed its effect in decline in lung cancer in seventies; whereas decline in smoking female population of the US of 1975s did not show its effect till 1992 statistics as composed by CDC (Center of Disease Control, Atlanta Georgia).

Why ban Smoking in public?

One inhales the air as well as exposed to air in the environment if that is smoke free by passive smoking even the effects like irritation of eyes do occur in others and people around a smoker are unwittingly exposed to risks those are faced by active smoker. More risk of asthmatic bronchitis has been found in passive smokers. Not only that, in a pregnant spouse if the husband is smoker fetus is also exposed to the risks of smoking that is tertiary smoking or smoking by proxy!

Other effects, apart from burning of eyes, as in response to above question?

Yes, Smokers run the risk of cataracts again gradual loss of eyesight, smoking stains teeth and gums also increases the risk of periodontal disease leading to swollen bleeding gums and risk of teeth to fall out, smoking also increases blood pressure a risk factor for heart attacks and stroke. Smokers have paler skin, acid taste in mouth and for men in their 30s & 40s, it increases the risk of ED (erectile dysfunction-impotence: erection can not occur because blood can not flow freely into the penis.

Finally, sense of smell and taste improves after quitting smoking, heart is less strained and general efficiency improves.

How difficult is to quit?

It is difficult. In Mark Twain’s words “It is very easy, I have done it many times”. Two things a). There is no single quit method which guarantees success. b). On an average it takes 4-5 attempts to give up and smokers who set a date to stop with will power and do their best to quit completely from a point of time, ultimately succeed. There are number of things that can help will power: Nicotine Replacement Therapy in the form of skin or gum patches or nasal spray. Bupropion is a medicine that has been awarded license to help smoking cessation. Behaviour modification programmes and alternate therapies like acupuncture, hypnosis and meditation.

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