The Perils of Smoke

Billowing smoke is a warning the community dreads and the call to action for firefighters. Where there’s smoke, there’s fire, but the Clean Air Act is ambivalent on incineration as it bans voluntary burning of trash in urban areas but consents in rural settings. Health authorities even urge smoke production as a means of dengue control.

But even the languid smoke wafting from the glow of a cigarette stick can be equally deadly to everyone in an enclosed space, children being the most vulnerable. Whatever raised the sudden alarm, six lawmakers are reported to be leading a bipartisan effort at the House of Representatives to pass legislation designed to scare smokers into quitting.

Led by Northern Samar Representative Paul Daza, the group is pushing a bill that would require tobacco companies to place “picture warnings” on their products to illustrate the dangers of smoking. The warnings will include images of tumors, diseased lungs and other graphic ill effects of the vice on smokers as well as the victims of second-hand smoke.

In a more pointed campaign, visitors to southern Philippines city of Davao get more than just a welcome message. Flight passengers for instance, would hear this admonition just before touchdown: "Welcome to Davao. We would like to inform you that there is a smoking ban in Davao City which is implemented in all public places and all transportation vehicles."

Those who enter and leave Davao will see huge billboards stating that Davao is a smoke-regulated city. Smoking is not allowed in parks as these are considered recreational places frequented by minors. Tourism increased in Davao as a result of the smoking ban,

Fighting for a Smoke-free Philippines

IT’S tantamount to murder every day,” says a lawyer tobacco-control advocate referring to the plight of nonsmokers exposed daily to secondhand tobacco smoke. As the legal adviser of the Framework Convention on Tobacco Control Alliance Philippines (FCAP), the organization instrumental in the country’s ratification of the Framework Convention on Tobacco Control (FCTC), which is the world’s first global health treaty signed by over a hundred nations in 2005. As a signatory of the treaty, the Philippines is bound to implement its full measure come September 2008

The Philippines, along with 35 other countries, is participating in the drafting of a guideline for an international law on the implementation of visual health warning on the packaging of tobacco products. The Framework Convention of Tobacco Control (FCTC) is an international public health treaty of the World Health Organization. Its goal is to formulate an international law on tobacco control strategies. The Philippines is now discussing the guidelines in the implementation of Article 11 of the FCTC which has to do with the packaging of tobacco products.

What is causing the entire hubbub? The discovery that the smoke emanating from a cigarette smoker could cause a risk of cancer to non-smokers in an enclosed space or in his immediate vicinity. Following are excerpts culled from the Web:

Secondhand smoke, also known as environmental tobacco smoke (ETS) or passive smoke, is a mixture of two forms of smoke from burning tobacco products. Sidestream smoke is "smoke that comes from a lighted cigarette, pipe, or cigar" and Mainstream smoke is "smoke that is exhaled by a smoker." according to the American Cancer Society

The US Environmental Protection Agency (EPA) has classified secondhand smoke as a Group A carcinogen, which means that there is sufficient evidence that it causes cancer in humans. Environmental tobacco smoke has also been classified as a 'known human carcinogen' by the US National Toxicology Program.

Secondhand tobacco smoke contains over 4,000 chemical compounds. More than 60 of these are known or suspected to cause cancer.

What is Secondhand Smoke?

Secondhand smoke is a mixture of the smoke given off by the burning end of a cigarette, pipe, or cigar, and the smoke exhaled by smokers. Secondhand smoke is also called environmental tobacco smoke (ETS) and exposure to secondhand smoke is sometimes called involuntary or passive smoking. Secondhand smoke contains more that 4,000 substances, several of which are known to cause cancer in humans or animals.

EPA has concluded that exposure to secondhand smoke can cause lung cancer in adults who do not smoke. EPA estimates that exposure to secondhand smoke causes approximately 3,000 lung cancer deaths per year in nonsmokers.

Exposure to secondhand smoke has also been shown in a number of studies to increase the risk of heart disease.

Serious Health Risks to Children

Children are particularly vulnerable to the effects of secondhand smoke because they are still developing physically, have higher breathing rates than adults, and have little control over their indoor environments. Children exposed to high doses of secondhand smoke, such as those whose mothers smoke, run the greatest relative risk of experiencing damaging health effects.

Exposure to secondhand smoke

• can cause asthma in children who have not previously exhibited symptoms.


• increases the risk for Sudden Infant Death Syndrome.


• Infants and children younger than 6 who are regularly exposed to secondhand smoke are at increased risk of lower respiratory track infections, such as pneumonia and bronchitis.


• Children who regularly breathe secondhand smoke are at increased risk for middle ear infections.


• can cause new cases of asthma in children who have not previously shown symptoms.


• can trigger asthma attacks and make asthma symptoms more severe.

Key findings:

11% of children aged 6 years and under are exposed to ETS in their homes on a regular basis (4 or more days per week) compared to 20% in the 1998 National Health Interview Survey (NHIS).

Parents are responsible for 90% of children’s exposure to ETS.

Exposure to ETS is higher and asthma prevalence is more likely in households with low income and low education levels.

Children with asthma have as much exposure to ETS as children without asthma.

Respiratory Health Effects of Passive Smoking (Also Known as Exposure to Secondhand Smoke or Environmental Tobacco Smoke - ETS) (U.S. Environmental Protection Agency, 1992) Key findings:

In adults:

ETS is a human lung carcinogen, responsible for approximately 3,000 lung cancer deaths annually in U.S. nonsmokers. ETS has been classified as a Group A carcinogen under EPA's carcinogen assessment guidelines. This classification is reserved for those compounds or mixtures which have been shown to cause cancer in humans, based on studies in human populations.

In children:

ETS exposure

• increases the risk of lower respiratory tract infections such as bronchitis and pneumonia.


• increases the prevalence of fluid in the middle ear, a sign of chronic middle ear disease.


• in children irritates the upper respiratory tract and is associated with a small but significant reduction in lung function.


• increases the frequency of episodes and severity of symptoms in asthmatic children. The report estimates that 200,000 to 1,000,000 asthmatic children have their condition worsened by exposure to environmental tobacco smoke.


• is a risk factor for new cases of asthma in children who have not previously displayed symptoms.

Secondhand Smoke: Questions and Answers

National Cancer Institute FactSheet

Key Points Secondhand smoke (also called environmental tobacco smoke) is the combination of smoke given off by the burning end of a tobacco product and the smoke exhaled by the smoker Of the chemicals identified in secondhand smoke, more than 50 have been found to cause cancer Secondhand smoke causes lung cancer in nonsmokers. Secondhand smoke causes heart disease in adults and sudden infant death syndrome (SIDS), ear infections, and asthma attacks in children. There is no safe level of exposure to secondhand smoke.

What is secondhand smoke?

Secondhand smoke (also called environmental tobacco smoke) is the combination of sidestream smoke (the smoke given off by the burning end of a tobacco product) and mainstream smoke (the smoke exhaled by the smoker). Exposure to secondhand smoke is also called involuntary smoking or passive smoking. People are exposed to secondhand smoke in homes, cars, the workplace, and public places such as bars, restaurants, and other recreation settings. In the United States, the source of most secondhand smoke is from cigarettes, followed by pipes, cigars, and other tobacco products.

How is secondhand smoke exposure measured?

Secondhand smoke is measured by testing indoor air for nicotine or other smoke constituents. Exposure to secondhand smoke can be tested by measuring the levels of cotinine (a nicotine by-product in the body) in the nonsmoker’s blood, saliva, or urine (1). Nicotine, cotinine, carbon monoxide, and other evidence of secondhand smoke exposure have been found in the body fluids of nonsmokers exposed to secondhand smoke.

Does secondhand smoke contain harmful chemicals?

Yes. Of the more than 4,000 chemicals that have been identified in secondhand tobacco smoke, at least 250 are known to be harmful, and 50 of these are known to cause cancer. These chemicals include (1):

arsenic (a heavy metal toxin)

benzene (a chemical found in gasoline)

beryllium (a toxic metal)

cadmium (a metal used in batteries)

chromium (a metallic element)

ethylene oxide (a chemical used to sterilize medical devices)

nickel (a metallic element)

polonium–210 (a chemical element that gives off radiation)

vinyl chloride (a toxic substance used in plastics manufacture)

Many factors affect which chemicals are found in secondhand smoke, including the type of tobacco, the chemicals added to the tobacco, the way the product is smoked, and the paper in which the tobacco is wrapped

Does exposure to secondhand smoke cause cancer?

Yes. The U.S. Environmental Protection Agency (EPA), the U.S. National Toxicology Program (NTP), the U.S. Surgeon General, and the International Agency for Research on Cancer (IARC) have classified secondhand smoke as a known human carcinogen (cancer-causing agent)

Inhaling secondhand smoke causes lung cancer in nonsmoking adults. Approximately 3,000 lung cancer deaths occur each year among adult nonsmokers in the United States as a result of exposure to secondhand smoke. The Surgeon General estimates that living with a smoker increases a nonsmoker’s chances of developing lung cancer by 20 to 30 percent.

Some research suggests that secondhand smoke may increase the risk of breast cancer, nasal sinus cavity cancer, and nasopharyngeal cancer in adults, and leukemia, lymphoma, and brain tumors in children. Additional research is needed to learn whether a link exists between secondhand smoke exposure and these cancers.

What are the other health effects of exposure to secondhand smoke?

Secondhand smoke causes disease and premature death in nonsmoking adults and children. Exposure to secondhand smoke irritates the airways and has immediate harmful effects on a person’s heart and blood vessels. It may increase the risk of heart disease by an estimated 25 to 30 percent. There may also be a link between exposure to secondhand smoke and the risk of stroke and hardening of the arteries; however, additional research is needed to confirm this link.

Children exposed to secondhand smoke are at an increased risk of sudden infant death syndrome (SIDS), ear infections, colds, pneumonia, bronchitis, and more severe asthma. Being exposed to secondhand smoke slows the growth of children’s lungs and can cause them to cough, wheeze, and feel breathless.

What is a safe level of secondhand smoke?

There is no safe level of exposure to secondhand smoke. Studies have shown that even low levels of secondhand smoke exposure can be harmful. The only way to fully protect nonsmokers from secondhand smoke exposure is to completely eliminate smoking in indoor spaces. Separating smokers from nonsmokers, cleaning the air, and ventilating buildings cannot completely eliminate secondhand smoke exposure. This means separating the smoking area in planes is a palliative, the efficient air filtration system removes most micron size particles but not all.

Agony of quitting

Senator Barack Obama is using nicotine gum to help him quit smoking. Now the question is, can he quit the gum?

The Senator said he started using the nicotine gum Nicorette about nine months ago. That’s six months longer than the three months recommended on the gum package label. He is not the only quitter who is still seeking a nicotine fix months after giving up cigarettes. A small percentage of the people who use nicotine replacement products like gums, patches or lozenges end up hooked on a new habit, say doctors who specialize in smoking cessation. Smoking cessation experts say they hope Mr. Obama’s use of nicotine gum will encourage smokers to try a nicotine replacement product to help them quit. Although nicotine therapy doubles a smoker’s chance of successfully kicking the habit, use of the products remains relatively low. “The problem is not that people use it too much. The greater problem is that they use it too little. People use it for a week, and then they are back smoking cigarettes.”

People often don’t stick with nicotine gums and lozenges because they dislike the taste. Another concern is that many people think nicotine is what makes cigarettes harmful. But nicotine is what makes cigarettes addictive. The harm comes from the combustion and release of 40 known carcinogens and other toxic chemicals into your body every time you take a puff.

Last month, a study in the medical journal Addictive Behaviors noted that part of the problem is that nicotine gums and lozenges have stricter labeling requirements than cigarettes themselves. Cigarette packages usually contain one simple boxed warning about the health risks of cigarettes, but package labels on smoking cessation products come with detailed warnings about use and side effects. The language leaves the impression that products to stop smoking are as risky or riskier than cigarettes themselves.

Doctors say their goal is to get more people to try nicotine replacement products as an aid to help them kick the smoking habit. Most people won’t get hooked on the nicotine products, but a few people will. One gun user who quit smoking a year and a half ago but still uses nicotine gum says when he smells someone else’s smoke, he goes for the gum.

A doctor says that once someone has stopped smoking, he tries to encourage patients hooked on nicotine gum to start substituting real gum from time to time. Another doctor says he encourages people to wean themselves off nicotine gum once they’ve quit smoking. But given a choice between being on Nicorette gum or going back to smoking, there’s absolutely no question the gum is better.

Comments of former smokers:

Nicotine is one of the most difficult addictions to beat, aggravated by its being legal and widely used. Cold turkey works for some, but not all. Gum or patch is a steppingstone to becoming smoke-free. It helps to have encouragement and support if you are seriously seeking to quit. Speaking from experience…

I wish some news media would investigate and publish the use of capsules or tinctures of the herb lobelia inflata to help smokers stop…it is fast, within a week; total cost less than $10.00; and it works. It worked for me and for others who were smoking 2 and 3 packs a day…so why not research it, and then try it! It couldn’t hurt….another benefit is it lessens physical pain…

Well, the good news is that a UK listed company Meldex International has just launched (5 November 07) a pleasant tasting oral film strip that delivers a hit of nicotine in less than a minute. Vitually as fast as a cigarette. Launched incidentally in Poland and early next year in China and India. I think gum will eventually become like an obsolete technology…

Long story short, I inevitably began smoking again because I still needed the gum. Thank heaven it is no longer prescribed so people can get it and use it as long as it takes to stay smoke free –for a person who has been smoking for decades it is unrealistic to believe that three months is a long enough period to use the gum…

The senator would be delighted to learn that his quit-smoking approach was endorsed last month by Britain’s Royal College of Physicians, one of the world’s oldest and most prestigious medical societies (In 1962 the Royal College published the first comprehensive study of smoking and health, two years prior to the US Surgeon General’s first report).

The Royal College’s new report, entitled “Harm reduction in nicotine addiction: helping people who can’t quit.” (http://www.rcplondon.ac.uk/pubs/brochure.aspx?e=234 ), provides hope for millions of inveterate smokers. It advocates a new approach called tobacco harm reduction, explaining “that smokers smoke predominantly for nicotine, that nicotine itself is not especially hazardous, and that if nicotine could be provided in a form that is acceptable and effective as a cigarette substitute, millions of lives could be saved

Harm reduction is a fundamental component of many aspects of medicine and indeed everyday life, yet for some reason effective harm reduction principles have not been applied to tobacco smoking. This report makes the case for radical reform to the way that nicotine products are regulated and used in society. The ideas presented are controversial, and challenge many current and entrenched views in medicine and public health. The principles behind them have the potential to save millions of lives. They deserve consideration. Nicotine is among the most powerful of addictive substances, but nicotine does not cause any smoking-related disease. In fact, nicotine itself is about as safe as caffeine, another addictive drug consumed safely by millions of Americans.

Brad Rodu

Professor of Medicine

Endowed Chair, Tobacco Harm Reduction Research

University of Louisville

Kudos to Dr. Rodu and his Tobacco Harm Reduction, Baton and his future “meldex”, all those who have managed to succeed against all ignorance in using nicotine (as harmless as caffeine) replacement therapy. What a shame that so few understand that tools are not ‘crutches’, willpower really is irrelevant for up to one half of smokers, and that replacement therapy is shamefully expensive. Some people need to start with 5 patches just to wean themselves. Studies have documented that many have alpha 7 nicotine receptors that take twice as long to desensitize, so the patch is useless, making the weaker gum more effective despite 3 times as long ’til relief, because it gives them needed spikes in nicotine levels. How many know that the gum and patch as directed have a pathetic 1 year success rate of under 14% while the spray is 89% effective and gives you a full 20th of what a cigarette does (in 2 minutes vs. 2 seconds). And that Chantix doesn’t warn that blocking nicotine uptake can make a small % of people broken or suicidal in mere days, but it helps the majority quit very quickly. And that there are blood tests to determine how much you are self-medicating with nicotine and thus what level of replacement to start at. Falling off the wagon can grow a bunch of hungry new neuroreceptors overnight, so health insurance and the government should subsidize these treatments that are (poorly) known to work, because billions of health $$ would be saved. I salute all who quit, and even more those who have had to use expensive trial and error (unnecessarily) to find the right nicotine replacement for them - no matter how long they have to stay on it. Pulmonary Diag. and Rehab Group in Palo Alto is an example of the too rare clinic (also did the trials for FDA approval of Nicotrol spray and Chantix) that can tell you that YES you CAN stop FOR GOOD this time without going nuts, by giving you enough replacement to prevent withdrawal from trashing your life. I suspect all those stubborn smokers who still smoke ‘for pleasure’ would immediately quit if they had access to current protocols and replacement therapy costing the same as coffee. I know multimillionaires on their 10th year of the gum, so I SALUTE Obama and people like him for their trail blazing inspiration! Good luck future ex-smokers everywhere!

Hall of Shame

Adding to our Pinoy collection of dubious achievements – high ranking in corruption and extra-judicial killings and bottom of the heap in science and math education – are drugs, alcohol and tobacco addiction.

In 1994, in terms of tobacco consumption of manufactured cigarettes, the Philippines ranked 15^th with some 85.36 billion cigarettes among the 25 leading countries. With respect to relative cost of cigarettes, smokers of 20 cigarettes a day spent 17% of their median household income for local cigarettes and 35% for imported brands in1989 (WHO 1997). At today’s prices, the average smoker blows away P100 a day into cigarette smoke.

In the Philippines, the results of the National Smoking Prevalence Survey of the Department of Health in 1995 indicated that 70% of the current and ex-smokers had finished only elementary or high school education, and that majority belong to the low-income levels. The survey results also showed that among 3,244 youths aged seven to 17 years old, 10% of them once smoked while 4% were current smokers, and the mean age of current and ex-smokers was 12 years old (DOH 1995).

The smoking prevalence derived from the Fifth National Nutrition Survey composed of 4,541 individuals aged 20 years and over in 1999 reported a smoking prevalence wherein 33% of adult Filipinos are current smokers while 13% are ex-smokers, that smoking prevalence among children, as derived from small surveys, is about 30% in urban areas with majority of them smoking from the time they were 13 to 15 years old.

According to a 1987 to 1988 survey among population subgroups, 63% of males and 37% of female physicians were smokers. Thirty-eight percent of respondents said they smoked in front of their patients, and only 59% advised patients on the ill effects of smoking (WHO 1997).

In a preliminary estimate made in the Philippines in 1999, approximately P27 billion will be spent of health care, P1 billion for productivity loss due to illness, while P18 billion will arise from productivity loss due premature death or an annual total of P46 billion for those suffering from smoking-related diseases (Dans et al., 1999).

Approaches to Developing National Plans of Action

Among the key strategies, WHO recommended national plans of action for comprehensive tobacco control that relates to legislative action. The list includes tobacco taxes to be used to finance tobacco control measures and to sponsor sports and cultural events; a ban on all forms of tobacco advertising, promotion and, sponsorship; a legal requirement for strong, varied warnings on cigarette packages; restriction of access to tobacco products, including a prohibition on the sale of tobacco products to young people; limitations on the levels of tar and nicotine permitted in manufactured tobacco products; strategies to provide economic alternatives to tobacco agricultural workers (WHO 1998).

While the sincerity of the legislators crafting the bill cannot be faulted, none of them have gone thru the agonizing withdrawal pangs, the anguish of suppression of craving of an ex-smoker. The ex-smoker knows from experience that success in weaning smokers from the tobacco addiction depends almost entirely on the patient’s will power. It takes three, four or more attempts by even determined quitters before success is achieved. One in denial will probably descend to his grave with a few sticks left in his pocket.

Physical activity and health

The evidence linking inactive living with a range of physical and mental diseases and disorders is now accepted by leading authorities world wide. People need to move more and more often. Unfortunately, the majority of the population, particularly those most likely to benefit, such as the middle aged and elderly, are unlikely to become more active. Individuals should take personal responsibility and establish lifestyles that involve healthier eating and more daily physical activity.

Physical activity refers to all energy expended by movement, including everyday activities, such as walking, cycling, climbing stairs, housework, and shopping, occurring as an incidental part of our routines. Exercise, on the other hand, is a planned and purposeful attempt to improve fitness and health that might include activities such as brisk walking, cycling, aerobic dance, and perhaps active hobbies such as gardening and competitive sports such as distance running, or lifting weight

In the past 20 years or so extensive evidence has established that inactivity causes illness and premature death. Those who maintain a reasonable amount of activity, particularly across the middle and later years, are twice as likely to avoid early death and serious illness, leading to the recognition of inactivity as the fourth primary risk factor for heart disease. Further good news suggests that the process of becoming fitter produces distinct benefits and it appears that it is never too late to make some changes and experience these positive outcomes.

Physical activity has both preventive and therapeutic effects.

Coronary heart disease and stroke

Coronary heart disease remains the leading cause of death in developed countries. Maintaining an active lifestyle, and a moderately high level of aerobic fitness, halves the chances of either dying from or contracting serious heart disease. There is a clear

dose response relationship, with the change from sedentary to moderately active producing greatest health benefits. Regular walking produces a reduction in CHD events, cycling to work, active commuting to work, and four hours of recreational activity per week or at least 800 kcals of leisure time activity per week are all associated with reduced risk.

The preventive and therapeutic effects of physical activity on stroke are less clear with studies showing inconsistent results.

Obesity

Obesity appears to be a direct result of environmental conditions that involve easy access to motorized transport, labor-saving devices, home screen entertainment, and cheap, high dens

ity food.. The evidence that reduced physical activity has been a determinant of this increase is

stronger than the evidence for increased energy intake

There are several prospective studies that indicate the benefits of an active and fit

lifestyle for the prevention of obesity.. Furthermore, those who maintain exercise are much

more likely to sustain any weight loss long term than those who rely on dietary management alone.

Perhaps the greatest benefit of physical activity for the obese is its impact on health risk profile. Reviewed observational studies concluded that obese people who managed to keep active and fit reduced their risk of heart disease and diabetes relative to non-obese levels. This would suggest that it is not unhealthy to be fat as long as you remain fit. It also puts into question whether obesity is more hazardous than inactivity.

Adult onset diabetes

There is strong evidence to show that inactivity may be a causal factor on the incidence of Type 2 diabetes. Prospective studies indicate a strong negative relationship between activity and contraction of diabetes, with risk reductions of 33-5

0% recorded for active groups .Walking, cycling and active hobbies such as gardening are associated with lower risk but it is likely that the greatest gains are made with moderate to vigorous activity. The strong relationship is plausible as the muscle is a critical site for glucose metabolism.

Exercise has been shown to delay or possibly prevent progression of glucose intolerance to the diagnosis of diabetes. Exercise also has benefits for those who are already diagnosed with diabetes. A small number of well designed studies have also shown that an activity program of walking or cycling, carried out three times a week for 30-40 minutes, is able to produce small but significant improvements in glycemic control in diabetics.

Cancer

Involvement in occupational or leisure time physical activity carries a reduced risk of mortality from cancer a leading cause of ill health and death. Moderate to vigorous activity appears to be most beneficial. The strongest protective effect is for colon or colorectal cancers producing a 40-50% risk reduction.

Physical activity also helps prevent lung cancer with a 40% risk reduction evident after control for smoking and other lifestyle factors. Similarly there are benefits for breast cancer but not prostate or testicular cancer.

There has been less attention paid to the impact of exercise in the treatment or management of cancer. Although there is as yet insufficient evidence to suggest that progress of the disease can be slowed by exercise, it does appear to have benefits for life quality including improved psychological well-being and reductions in fatigue and nausea.

Bone and muscle health

Diseases such as low back pain, osteo-arthritis and osteoporosis are a major cause of human suffering, reduced life quality and lost work productivity. Exercise training produces stronger muscles, tendons and ligaments and thicker more dense bone which improves functional capacity and allows greater independent living in older people. Physical activity programs designed to improve muscular strength also helps older adults to maintain balance and a reduction in falls. It can be effective in preventing low back pain and also reduces reoccurrence of back problems. Physical activity has not been shown to prevent osteo-arthritis but walking programs have indicated important beneficial effects. Exercise can reduce pain, stiffness and disability and improve strength, mobility and overall ratings of life quality.

Exercise training involving, weight bearing moderate to vigorous activity, can increase bone mineral density and bone size in adolescents, help maintain it in adults and slow decline in older age. This in turn prevents or delays the onset of osteoporosis but cannot reverse osteoporosis once it has developed. The effect is specific to those bones loaded by the exercise.

Mental well-being

The case for physical activity and health has largely been made on the evidence for its prevention of diseases such as CHD, cancer, obesity and diabetes. The World Health Organization has estimated that mental illness, largely in the form of depression and anxiety, will be the leading cause of disability and a major cause of loss of life by the year 2020. In addition to increased incidence of serious mental illness there is concern for the increasing numbers who suffer chronic or recurrent mild to moderate symptoms of depression. Several well designed studies have now shown that physical activity can reduce clinical depression.

Exercise can be as effective as traditional treatment such as psychotherapy as it can offer a cheap alternative. Physical activity also improves psychological well-being in those who are not suffering from serious mental disorders. Several hundreds of studies have documented improvements in subjective well-being, mood and emotions, and self-perceptions such as body image, physical self-worth and self-esteem. Furthermore, both single bouts of activity and exercise training reduce anxiety stresses, and also improve quality and length of sleep.

Physical activity is particularly helpful for older people as it reduces risk of dementia and Alzheimer disease and improves executive aspects of mental functioning such as planning, short-term memory and decision making. Clearly, physical activity has tremendous potential to improve quality of life throughout the lifespan.

Risks of physical activity

The risk of sudden cardiac death is elevated by five times during vigorous exercise for fit individuals and 56 times for unfit individuals. Any risks accompanying exercise are far outweighed by the benefits and the reductions in disease risk that fitness brings. There is also an increased risk of injury, particularly to feet, ankles and knees, while taking part in exercise or vigorous sports.

Physical activity recommendations

When people become more active, they reduce their risk of early death from heart disease, some cancers and diabetes. They manage their weight better, increase their tolerance for physical work, and they improve their muscle and bone health. They are also likely to improve their psychological well-being and life quality. And, physical activity has the potential to add years to life.

For many years, exercise and health promoters adopted training guidelines for the improvement of cardiovascular fitness involving vigorous exercise using large muscle groups in continuous work for a minimum of 20 minutes at an intensity equivalent to 60-80% of maximum heart rate. Unfortunately, after almost two decades of promoting this there has been little increase in the people exercising at this level. It seems that it is too rigorous for most people. The evidence also indicates that it is not essential to work so hard in order to appreciate health gains. There is a curve of diminishing returns regarding physical activity level and health benefit with the greatest gains to be made by individuals changing from the sedentary to moderately active category.

The physical activity promotion message is now to take regular activity of a moderate intensity, equivalent to brisk walking, is thought to be achievable by a much larger percentage of the population as it can be reasonably incorporated into daily routines and is less physically demanding. Current recommendations emphasize brisk walking on most or all of the days of the week for 30 minutes at a time, even when the same amount is taken in two or three shorter bouts.

This is essentially a general recommendation. Different types and intensities of activity will improve different elements of health and fitness. For example, a gentle stroll at lunchtime, although not sufficiently intensive to create an improvement in circulatory fitness, may provide a healthy break from work, enhance mood and reduce stress, while also contributing to weight management. The accumulation of small but regular periods of movement during work or leisure can also make a significant difference to energy balance and weight control in the long term. Simply standing for one hour instead of sitting watching TV each day, for example, will expend the equivalent of 1 - 2 kgs of fat per year. A daily 20-minute brisk walk will make a difference of 5 kgs per year, and for most people there will be improvements in cardiovascular fitness and potential for other physical and mental health benefits.

There may also be a benefit in reducing the amount of time spent in sedentary persuits such as watching television. To provide maximum benefits for all areas of the body, a range of specific strengthening and stretching exercises will also be needed. This is particularly important for older people.

• Involve large muscle groups


• Impose more than a customary load


• Require a minimum total of 700 kcal/week


• Be performed regularly and if possible daily

In practice, sustained rhythmic exercise, such as brisk walking for 20-30 minutes would fulfill this requirement in most adults.

For further maximum health benefits, activities should:

• Include some periods of vigorous activity


• Include a variety of activities


• Exercise most of the body’s muscles, including trunk and upper body


• Expend up to 2000 kcals/week


• Be maintained throughout life

Calisthenics

The Japanese work ethic includes some calisthenics (mild physical exercise) during the workday. They believe the workout helps promote productivity. Some American companies are studying the validity of the relationship, but a few firms are not exactly convinced. This sign was posted on a company bulletin board: “This firm requires no physical fitness program. Everyone gets enough exercise jumping to conclusions, flying off the handle, running down the boss, flogging dead horses, knifing friends in the back, dodging responsibility, and pushing their luck.”

Energy Used in Activities – (Use this guide to obtain an approximation of the calories you burn daily compared to the calories you ingest. If input consistently exceeds output, you need to burn more calories.)

Calories burned by a 130-lb person performing the following activities for an hour:

Around the house –

Mopping floor – 224

Cleaning windows – 216

Washing dishes – 168

Cooking – 164

Doing laundry – 156

Dusting – 148

Making a bed – 144

Ironing – 116

Talking on phone – 88

Sleeping – 72

Pleasure –

Walking dog – 284

Pushing baby stroller – 228

Gardening – 200

Baking cookies – 128

Writing a love letter – 104

Holding hands – 80

Reading a book – 76

Watching TV – 76

At Work

Strolling – 124

Writing at desk – 104

Sports

Bowling – 250

Golf – 230

Swimming, ¼ mph – 270

Volleyball – 320

Roller skating – 320

Bicycling 5 ½ mph – 190

Chores

Mowing lawn – 396

Shoveling dirt – 372

Painting outside – 272

Weeding – 252

Raking leaves – 192

Painting inside – 120

Others

Running – 420

Climbing hill – 360

Walking moderate – 180

Walking fast – 270

Driving car – 160

Standing – 100

Sharpening pencil – 104

Writing at desk – 104

Typing (electric) – 96

Attending a meeting – 72

Diet and Exercise Prolongs Life

Very recently two new studies based on a large U.S. diet and health survey demonstrate the benefits of exercise and diet in reducing health risks and prolonging life.

The first shows people who follow a Mediterranean-style diet rich in vegetables, fruits, whole grains, and healthy oils, such as those found in fish, olives, and nuts, were less likely to die of cancer, heart disease, or any other cause over a five-year period.

The second shows people who engaged in moderate exercise like walking for at least 30 minutes a day most days of the week, as recommended by national guidelines, were 27% less likely to die during the study than non-exercisers. Even a smaller amount of exercise produced benefits in reducing the risk of death over the short-term, but those healthy benefits increased with more frequent and vigorous exercise.

The studies, published in the Archives of Internal Medicine, were both based on data collected from the National Institutes of Health-AARP Diet and Health Study involving 566,407 AARP members aged 50 to 71 in six U.S. states who filled out diet and exercise questionnaires between 1995 and 1996.

In the first study, researchers looked at the effect of the Mediterranean diet on the risk of death over five years. This diet has gained in popularity in recent years thanks to research that shows countries that follow the diet, rich in fruit and vegetables and low in saturated fat, have lower rates of heart disease and other health problems. This study confirmed those healthy effects and showed men and women who followed a Mediterranean diet were 20% less likely to die from any cause during the study.

In the second study, researchers compared the risk of dying during the study to rates of exercise. The results showed that people who were moderately active for at least 30 minutes a day, most days of the week were 27% less likely to die than those that were inactive. The health benefits of exercise increased with more vigorous activity. Those who engaged in vigorous activity had a 32% lower risk of death during the study; a level of physical activity that was less than recommended was linked to a 19% lower death risk.

One final benefit in becoming active – you save on electricity bills when the TV is switched off while doing the chores.

Cheaper Medicines Bill

Cheaper Medicines Bill

For lack of quorum in the waning weeks of the House, 13^th Congress, the Cheaper Medicines legislation was killed. Retrieving the Bill, its successor the 14^th Congress is attempting to pass the legislation before the 2007 Christmas break, raising some anxiety and stress to the eagerly awaiting ill and hypochondriac pill-poppers. The obstacles delaying passage are the debates, lobbying of all-powerful Big Pharma and even from the medical community

Debate on cheaper meds

Philippine College of Physicians (PCP) expressed, in a full-page advertisement, their unqualified support for the efforts to bring down the cost of medicines. (Inquirer, 11/25/07) but fears about the effects of a Cheaper Medicine law on therapeutic efficacy and safety. PCP’s argument—that making medicines affordable would undermine drug safety and efficacy, and avers the bill promotes practice-of-medicine-at-the-drugstore-counter.

Medical Action Group Inc. (MAG) disputes the PCP claims. They allege the World Health Organization (WHO) has been actively campaigning for the use of generic equivalent to medical treatment, even encouraging physicians to issue prescriptions using generic names only. The Cheaper Medicine bill seeks to address the lack of affordable medicines for Filipinos, not replace the physicians’ authority and responsibility in determining the appropriate and safe treatment for their patients. The fact is that one of the reasons why most Filipinos have not followed prescribed treatment is because of their incapacity to buy prescribed medicines. Statistical data show that in 2006, a meager 2.9 percent is being spent on medical care by a Filipino family.

Don’t count your chicks yet, folks. The bill may not be potent enough to neutralize the deviousness of Big Pharma and its cohorts in the medical community. Are there other means to maintain public health? You bet!

Chronic (non-communicable) diseases and practice of prevention is preferable to the current paradigm of ‘popping pills’, the modern conventional medicine. It’s much cheaper and less stressful. Medical science knows that 80% of chronic non-communicable disease (heart disease, strokes, diabetes, high blood pressure and cholesterol) and 30% of cancer can be prevented with proper diet, physical activity and avoidance of tobacco.

Pending the promulgation of the provisions of the so-called Cheaper Medicines Bill it is premature to comment on its merits. But one contentious item in the debates that is disturbing is the setting up of a Drug Price Regulatory Board for its potential to boost corruption. An editorial speculating on the acrimonious debates foresees a watered down version. This would be a pity, a waste of valuable resource. Water is too precious to waste for watering down feeble and ineffective bills purporting to boost public healthcare. Public health policy must focus on protecting the health of the teeming healthy public and preventing disease, both the infectious and the chronic non-communicable type (yes, they are preventable). Suggestion: ensure sustained supplies of clean water and safe food (restrain junk and unhealthy food); use water to wash hands and food to avoid diarrhea and obviate the need to buy medicine.

Chronic (non-communicable) diseases—including cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes—are leading causes of death and disability but are neglected elements of the global-health agenda, and, not surprisingly, this includes the Philippines. WHO has proposed a global goal for the prevention and control of chronic diseases to complement the Millennium Development Goals. A British medical journal, the Lancet, published a five part series in pursuing the goal. “Achievement of the global goal would avert 36 million deaths by 2015. Furthermore, because most of the averted deaths would be in low-income and middle-income countries and about half would be in people younger than 70 years, it would have major economic benefits, including extension of productive life and reduction in the need for expensive care.”

Joining the chorus, several of the world's most eminent health scientists and organizations have published, in their study featured in Nature magazine, a landmark global consensus on the 20 foremost measures needed to curb humanity's most fatal diseases, Known as chronic, non-communicable diseases, they are reaching world epidemic proportions and include cardiovascular diseases (mainly heart disease and stroke), several cancers, chronic respiratory conditions, and type 2 diabetes.

In their paper for Nature, the 19 authors say chronic non-communicable diseases:

• Cause the greatest share of death and disability worldwide;


• Account for over 60% of deaths worldwide, four-fifths of those fatalities being citizens of low and middle income countries;


• Cause twice as many deaths as the combined total of HIV/AIDS, tuberculosis, malaria, maternal and pre-natal conditions, and nutritional deficiencies.

CNCDs, defined by the WHO as cardio-vascular disease, type 2 diabetes, chronic respiratory diseases and certain cancers, are largely preventable. It's estimated that eliminating key risk factors (poor diet, physical inactivity, smoking) would prevent 80% of heart disease, strokes and type 2 diabetes, and over 40% of cancer cases.

The initiative's leaders say their goals are "to galvanize the health, science and public policy communities into action on this epidemic," and to foster global debate, support and funding.

The Grand Challenges are grouped under six broad goals: (The Lancet proposal is essentially similar)

• Reorient health systems (e.g. Grand Challenge: "Allocate resources within health systems based on burden of disease");


• Mitigate health impacts of poverty and urbanization (e.g.: "Study and assess how poverty increases risk factors");


• Engage businesses and community (e.g.: "Make business a key partner in promoting health and preventing disease; Develop and monitor codes of responsible conduct with the food, beverage and restaurant industries");


• Modify risk factors (e.g.: "Deploy universally measures proven to reduce tobacco use and boost resources to implement the WHO framework Convention on Tobacco Control");


• Enhance economic, legal and environmental policies (e.g. "Study and address the impacts of poor health on economic output and productivity"); and


• Raise public and political awareness (e.g.: "Promote healthy lifestyle and consumption choices through effective education and public engagement").

While these challenges are applicable to all countries, different nations should identify local priorities from among those identified here for immediate attention, depending on resources and disease Inaction is costing millions of premature deaths throughout the world offsetting the gains from a decreasing burden of infectious diseases. “In developing countries, many beset by infectious diseases, authorities have not resourced or thought through the policy implications of addressing these silent killers. But that's like putting out one fire in a house burning from both ends," says one scientist.

Lifestyle Changes

An American health journal summarizes the lifestyle choices you should do to help prevent chronic diseases, such as diabetes, heart disease, stroke respiratory and certain types of cancer. If you have such disease or are at high risk to develop it, you should do the following:

• Eat plenty of vegetables and fruits while avoiding trans fats and saturated fats.


• Keep blood pressure in the normal range, ideally with a systolic blood pressure of less than 120 millimeters of mercury (mm Hg).
  
  

  

• Don't smoke.

• Strive to keep your blood sugar levels normal.


• Manage stress.


• Become more physically active, and make daily exercise a priority at an intensity level recommended by your doctor.

High LDL cholesterol is one of the major risk factors for heart disease, and the risk increases as the bad cholesterol level rises. Other major risk factors are smoking, high blood pressure and diabetes. Your cholesterol level is determined by your genetic makeup and the amount of saturated fat and cholesterol in the foods you eat. The liver manufactures cholesterol, so even if you never eat cholesterol, your body can make all it needs.

Several factors contribute to high blood cholesterol:

Diet: Reduce your blood LDL cholesterol level by eating less fat, particularly saturated fat (as found in whole milk, cheese and meat). Low cholesterol foods are important, too. Studies have shown that your total cholesterol and your bad cholesterol levels may begin to drop two to three weeks after you begin your lower you intake of fat, calories and cholesterol.

A healthy diet:

• Contains healthy fats. Once you've cut way back on saturated fats and trans fats (the unhealthy fats), you can start adding healthy fats to your diet. Healthy fats are polyunsaturated and monounsaturated.


• Contains healthy sources of carbohydrates. Eat more whole grains — foods like whole-wheat bread, brown rice and oatmeal — to help lower cholesterol, improve blood sugar and insulin levels, control weight, protect the heart, guard against diabetes and keep your digestive system healthy.


• Relies on healthy sources of protein. For a healthier heart, cut back on red meat and switch to fish. The good fats in many types of fish help protect the heart against erratic rhythms and may prevent blood clots. Wild-range fish are preferable to farmed fish. The American Heart Association recommends that people eat fish (especially fatty fish) at least two times per week. Beans, nuts and seeds are also excellent sources of protein.


• Includes plenty of fruits, vegetables and whole grains. These foods have more powerful effects on your health than most pills.


• Tastes great. If it doesn't, you probably won't stick with it for long.

Weight control: Obesity increases triglyceride and total blood cholesterol levels, blood pressure and the risk of developing diabetes.

Exercise: Regular exercise or continuous physical activity may help a person control weight, lower blood pressure and increase the level of high-density lipoprotein, or HDL (good), cholesterol.

Genetic factors: Understand that lowering your LDL cholesterol levels through diet often is not enough to reach your goal. Many people are genetically programmed to produce cholesterol in the liver no matter how strictly they follow a diet.

Sex/age: Coronary heart disease is the leading cause of death and disability for both men and women in the United States. Traditionally, coronary heart disease has been associated much more with older men than women. However, today, the importance of lifestyle changes is recognized for both sexes at all ages.

Alcohol: In some people, modest amounts of alcohol can increase the amount of good cholesterol (HDL). Modest intake means two or fewer drinks per day for men and one drink per day for women. There is good evidence that moderate alcohol intake lowers the risk of coronary artery disease, whether or not the protection is due to increasing HDL levels. However, alcohol provides "empty calories" that can add to your weight, and because drinking can have serious adverse effects, present guidelines do not recommend drinking alcohol as a way to prevent heart disease.

Smoking: Smoking damages the heart by raising blood pressure, damaging blood vessels, promoting the buildup of fatty plaque in arteries, lowering levels of "good" cholesterol, making the blood more likely to clot and depriving the heart of oxygen. Quitting smoking is the best thing you can do to prevent a heart attack.

Stress: Stress can increase chemicals within the body that may increase the risk of a heart attack. These fight-or-flight stress hormones, such as cortisol and epinephrine, excite the heart and make it work overtime.

The Lancet provides evidence that this goal is not only possible but also realistic. The major drawback is that it requires the cooperation and coordination of many sectors of society, unprecedented in contemporary Philippine milieu. But a city in the U.S., unaware of the Lancet agenda, is actually undertaking an experiment with the similar goal of preventing chronic disease

Heart-disease prevention target of Baltimore plan

Churches, barbershops and other unlikely allies would take part in a communitywide assault on heart disease proposed by the Baltimore City and Baltimore County health officers. The plan focus will be on simple measures known to prevent the disease or lessen its impact. These include smoking cessation, low-salt diets, exercise and taking medications as prescribed and recommending lifestyle changes to make better food choices on a daily basis The proposal, which is a set of principles and suggestions, has been under development for about a year and is the product of meetings with public health experts. The health officers have posted the proposal on the Internet and are inviting people to submit ideas. Public hearings are scheduled.



Elements of the proposal were borrowed from other cities and countries. Some represent programs that had brief stints in Baltimore. The Johns Hopkins School of Medicine ran a program called Heart, Body and Soul between 1998 and 2002 that involved churches in the promotion of healthy lifestyles. The proposal calls for the recruitment of churches and other faith-based institutions to sponsor health screenings and prevention programs. It also calls for the training of laypeople to become "community health workers" who could accompany patients to medical appointments, refer them to social services and administer blood pressure tests. It also envisions an expansion of the number of barbershops and beauty parlors involved in blood-pressure screening.



The proposal calls for the formation of a task force that would consider ways to get restaurants, grocers and food manufacturers to reduce their use of salt. Several countries, including England, Ireland, New Zealand, Australia and Finland, have reduced dietary salt through voluntary measures or labeling requirements.



The plan keeps an open option as to whether to seek voluntary salt reductions or impose rules on restaurants and food manufacturers. This year, New York prohibited restaurants from cooking with anything more than minute amounts of trans fats, substances implicated in heart disease. A Hopkins professor of medicine and public health who ran the Heart Body and Soul program, said prevention programs inevitably compete with a fast-food industry that propagandizes people to eat unhealthy foods.

Filibuster

Back to the progress of the Bill, Congress has only a few more days before their X’Mas vacation and tensions are building up. Congressman Pablo Garcia is unrelenting in blocking passage to a law he asserts is under lobby by Big Pharma, is a farcical placebo. Malacañan is cornered into a quandary, what move to take: support or veto a law that mandates lower prices for placebos?