Enlightened approach in the face of inconclusive evidence

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Photo: youtube screen-grab

By Mohamed Saleem Mohamed Ibrahim

The theme of this year’s World No Tobacco Day on the 31st of May is the effect tobacco has on the cardio vascular health of smokers worldwide. This societal scourge kills more than 7 million people across the globe every year and is responsible for burdening the global economy with an estimated $1.4 trillion in healthcare costs and lost productivity!

Indeed, countries all over the world grapple with various tobacco control measures in a bid to stem the rising tide of smoking; especially amongst the youth. Notably, Singapore and Australia are at the forefront of a plethora of tobacco control measures.

For instance, since June last year, food establishments have not been allowed to apply for new smoking corners. Since August 1 last year, the point-of-sale display of tobacco products was banned. The minimum legal age for smoking will also go up to 19 on Jan 1, 2019, 20 on Jan 1, 2020 and 21 on Jan 1, 2021. Other measures include price hikes, smoking ban at common areas like HDB void-decks, shelters and parks.

Another laudable move is the impending smoking ban throughout the entire stretch of Orchard except for certain designated ‘yellow boxes’. This would definitely protect non-smokers from second-hand smoke; especially in a highly dense area like Orchard.

However, despite the slew of tobacco control measures implemented by Singapore, the proportion of smokers aged between 18 and 69 has plateaued around 13% since 2013. In other words, smokers have proven themselves to be highly resilient to the slew of tobacco control measures.

Price hikes hurt the pockets of smokers. However, they also pave the way for the rise of a ‘shadow economy’ in contraband cigarettes; easily available in the alleyways of Geylang.

Arguably, tobacco control measures inconvenience the smoker but do not deter him from indulging in his addiction.

A smoker carries many pre-conceived notions of why he is actually smoking. Smokers usually cite reasons such as stress and peer pressure for their inability to quit smoking. Others may claim that they feel ‘empty’ without a cigarette especially after a meal. Almost all would unanimously agree that it is a habit albeit one that is almost impossible to break free.

In fact, the overarching reason for a smoker to continue smoking is the addiction to nicotine. Nicotine is the monster that keeps the smoker enslaved to the cigarette. Although the withdrawal symptoms are almost imperceptible, a smoker continues to feed his addiction for years eventually succumbing to one of the many smoking-related diseases.

The Government must adopt an enlightened approach to tackle this malignant problem. Half a decade of the tried and tested measures have not yielded positive results as seen from the ratio of smokers in Singapore still enslaved to the habit.

Cessation clinics in Singapore can play a bigger role in engaging smokers who are genuine about quitting the habit. Agencies engaged in this fight against smoking should seriously consider the use of e-cigarettes as an alternative quitting-aid.

Research for Public Health England concluded that e-cigarettes were 95 percent less harmful than traditional combustible cigarettes. Elsewhere in Scotland, the national health education and promotion agency published a consensus statement stating that e-cigarettes are definitely less harmful than smoking tobacco. In a surprise move, the US Food and Drug Administration also announced a comprehensive regulatory plan in July last year which included the adoption of e-cigarettes in the fight against tobacco. In the same breath, a major study by Public Health England also discovered that for teens who do not smoke, e-cigarette experimentation did not lead to regular use; thus discrediting the gateway effect.

Although we are unable to pinpoint exact scientific evidence to claim that e-cigarettes are 100 percent safe for long-term use, preliminary research and data have proven that e-cigarettes contain 95% less harmful chemicals as compared to heated tobacco which validate their use as an interim quitting-aid for current smokers.

Our policies are geared towards de-normalising smoking. However, we also need to ensure that current smokers are provided the help they deserve to quit smoking. Not all smokers will take the brave attempt to quit smoking by going cold-turkey. Many require nicotine replacement as they gradually wean themselves away from cigarettes.

We thus need a regulatory system that can protect our youth while enabling smokers to have access to safer alternative nicotine products such as e-cigarettes to help them quit their smoking habit. The lives of more than half a million smokers in Singapore are at stake in this fight against smoking.

Rather than waiting for exact scientific evidence to arrive at our doors, let’s take this enlightened approach to regulate the use of e-cigarettes knowing that smokers can expose themselves to 95 percent less harmful chemicals as they attempt to quit their habits.