Physicians urged to champion fight against smoking

With an annual death toll of nearly eight million people, around twice as many lives as Covid-19 has claimed, cigarette smoking is considered the leading cause of preventable deaths in the world today.

CAPE TOWN, January 13 (ANA) – A new international report is urging physicians and health care workers to champion the fight against cigarette smoking.

With an annual death toll of nearly eight million people — around twice as many lives as Covid-19 has claimed — cigarette smoking is considered the leading cause of preventable deaths in the world today.

Annually around 6% of global health budgets are allocated to the treatment of smoking-related diseases like lung cancer, chronic obstructive pulmonary disease, heart disease and tuberculosis.

South Africa is home to nearly 12 million of the world’s 1.14 billion tobacco users, the report by the International Commission to Reignite the Fight Against Smoking found.

The study calls for a more nuanced, holistic discussion around smoking and an acknowledgement of the many recent innovations in Tobacco Harm Reduction (THR) technology, said Dr Kgosi Letlape, past president of the Health Professions Council of South Africa.

In part because of outdated curricula in medical, dental and nursing schools, a “Smoking kills. Quit-or-die!” narrative which largely ignores these novel therapies and devices has prevailed among physicians.

“In the previous century, physicians were our flag bearers, leading the charge against tobacco-use, and setting an example by quitting in droves themselves. Especially after the 1962 Royal College of Physicians report that, for the first time, definitively linked cancer to combustible tobacco”, Letlape says.

“This ushered in an era of ‘coercive permissiveness’ in healthcare, during which physicians began to routinely offer unsolicited holistic lifestyle advice to patients. As the second-most trusted grouping of professionals in the world – more so even than state governments, civil society bodies or NGOs, and outranked only by scientists – physicians have enormous influence and should reclaim their place as the natural leaders of international cessation efforts.”

The report finds that even among physicians, misinformation is rife.

“Many HCWs (health care workers) still lack knowledge around THR, and falsely believe that ‘cold turkey’ quitting, which many smokers find impossible, is the only available option,” Letlape notes.

A key finding is that globally, an overwhelming majority of health care workers erroneously believe the nicotine in cigarettes is carcinogenic and is as dangerous as other extremely toxic cigarette ingredients. Most respondents surveyed had never received training in tobacco cessation services.

“The science so far indicates that e-cigarettes and vaporisers are far less harmful than their combustible counterparts. But these alternatives are not completely harm-free, and physicians in LMICs ( low- and middle-income countries) like South Africa may be reluctant to advise their use,” Letlape said.

“This is well-intentioned, but misguided: Just like vaccines and other medical technologies, THR technologies are not completely risk-free, but nevertheless their potential benefits far outweigh the possible harms.”

In low- and middle-income countries where 80% of the world’s smokers reside, there are dire shortages of health care workers in many regions. Physicians are severely overworked and under immense psychological pressure. In Africa, 29% of physicians are smokers themselves.

“With the burdens of many other pressing diseases to deal with, South African doctors simply do not have the time to adequately address smoking or educate themselves on the latest advancements in the THR field. Nor are they being compensated specifically to do so”, says Letlape.

He says targeted support for physicians could empower them to bring harm reduction solutions to their patients, especially within marginalised groups whose smoking prevalence rates are disproportionately high.

“This support may come in the form of easy-to-access, knowledge and information campaigns, with instruction updated every few years to keep abreast of the latest developments, innovations, and refinements to best practice,” Letlape says.

He endorses the National Cancer Institute’s “five A’s approach” for medical professionals: Ask about tobacco use, Advise quitting, Assess a willingness to quit, Assist in the attempt to do so, and Arrange follow-up meetings.

Medical research professionals should also prioritise effective cessation strategies for high-risk patients who smoke, including those with mental health conditions, tuberculosis, heart disease and early-stage chronic lung disease, Letlape says.

“Physicians now have the most powerful tool in history to combat smoking – technology that delivers nicotine without the massive health-risks associated with tobacco combustion,” he says.

“With this at their disposal, they can once again take their place at the helm of international cessation efforts, and continue to save lives, as they did in earnest over 60 years ago.”

– African News Agency (ANA), Editing by Stella Mapenzauswa