Tobacco Menace: A preventable Tragedy of Human health & Longevity

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Integrating Pharmacotherapy into Tobacco Control in Low-and Middle – Income Countries-A critical Need. Half of people who don’t stop using tobacco die prematurely from tobacco-related disease and those who quit have a substantially reduced risk of tobacco-associated premature death. “80% of the 1.3 billion people worldwide who use tobacco”.

Behavioural therapy combining it with pharmacotherapy is associated with higher abstinence rates. LMICs(Low and middle income countries) have high rates of tobacco use; with more diverse array of tobacco products, such as smokeless tobacco.

Limited resources in LMICs may also weaken the capacity of governments to counter the tobacco industry’s marketing and lobbying . The WHO treatment guideline identifies nicotine-replacement therapy (NRT), varenicline, bupropion, and cytisine (A newer drug) as safe and effective pharmacotherapy options to support smoking cessation.

Information and education regarding risks associated with tobacco use should include information about all cessation treatments. In some high-income countries (e.g., New Zealand, the United Kingdom, and Canada), e-cigarettes are recommended by some public health agencies or health systems as cessation aids for some combustible-tobacco users, whereas in several LMICs (e.g., Cambodia, Ethiopia, and India), sales of these products are banned)

Pharmacotherapy needs to be affordable, readily available for all tobacco users, and incorporated into national health systems and universal health coverage frame works.

According to Dr. G C Khilnani, “In India 28.6% of adults consume tobacco in some form ( bidis, cigarettes, hookah, Khaini, Gutka paan masala etc. causing 1.35 million deaths annually. Sadly, 8.5% of adolescents (13-15 yrs) use tobacco in some form in India. Unfortunately, India is the second-largest consumer and producer of tobacco in the world We know that addiction to nicotine (Tobacco) starts at early age and despite wanting to quit only 7.5% are able to quit tobacco use in long run. This article published on 18th September 2025, in word’s most prominent medical journal (New England Journal of Medicine) highlights the importance of pharmacotherapy (Medication) along with behavioural therapy and counselling.

The authors also recommend that provision of smoking cessation drugs should be part of public medical services. In some countries (UK, Canada) electronic cigarettes are approved for smoking cessation strategies. However, In India it is banned by law because of its harmful effects and addiction potential as one continues to take nicotine (higher quantity).

In my thinking, all efforts should be made to stop young children from picking up this dangerous habit which leads to addiction. The education should start in school and social media (which is a powerful tool these days). Great efforts have been done by the Government by banning tobacco smoking at public places, increasing taxes, printing health warnings on cigarette packs and starting smoking cessation clinics and help lines. More efforts are needed to create further public aware ness with mass media campaign.

As a practicing Pulmonologist, it is indeed painful to see patients with tobacco related serious diseases such as lung cancer (Number one cause of cancer death), COPD (3rd leading cause of death and other cancers for which very few remedies are available to medical practitioners.

Awareness is the key and dissemination of knowledge is the way to prevent this menace from causing harm to mankind. While Western world has been able to reduce tobacco use leading to decline in lung cancer and other diseases, a lot needs to be done in our country. Prof (Dr)G C Khilnani Chairman, PSRI Institute of Pulmonary, Critical care and Sleep Medicine. Formerly Prof and Head of Pulmonary, Critical care and Sleep Medicine, AIIMS, New Delhi 9810353696 gckhil@gmail.com PL CIRCULATE TO DISSEMINATE INFORMATION