Smoking doesn't make you happy.

Smoking doesn't make you happy.

Smokers who claim that smoking is one of the few pleasures left to them should think again. Extensive research carried out by Dr Iain Lang at the Peninsula Medical School in England looked at the relationship between smoking and psychological wellbeing.

Said Dr. Lang: "We found no evidence to support the claim that smoking is associated with pleasure, either in people from lower socio-economic groups or in the general population." In short -- smoking doesn't make you happy.

Some countries set No Smoking Day on 12th March hoping to persuade smokers to quit as a patriotic gesture and sacrifice (by stopping production of harmful second-hand smoke). Here are some of the tips.

A Quit Smoking Diet?

Can what you eat help you give up smoking?

Yes, according to Duke University psychologist F. Joseph McClernon. Based at the Duke Center for Nicotine and Smoking Research, McClernon “… kept hearing smokers say that certain foods and beverages made their cigarettes taste much better.” He began to wonder exactly which foods these were — and whether any foods made smoking a worse experience.”

Which, of course, got him thinking about the connection between foods and smoking. He enlisted 209 long term smokers (who smoked at least a pack a day for at least 21 years) and had them list the foods that seemed to enhance the smoking experience and the foods that seemed to worsened the smoking experience.

The results…

70% of the participants found that meat, alcohol, and caffeinated beverages appeared to make cigarettes taste better.

But for 45% of the participants, foods such as fruit, vegetables, dairy products, and beverages such as water, juice, and non caffeinated drinks appeared to make their cigarettes taste worse.

What this means…

So what do the smokers out there think?

Have you tried diet modification in your quit smoking campaign ?

Overlooked Reasons to Quit Smoking

If you need more incentive to quit smoking, here are some reasons that you may not know about.

You know smoking causes lung cancer, emphysema, and heart disease, but you're still lighting up. To help you get on the wagon, following is a compiled list of little known ways your life can go up in smoke if you don't kick the habit.

From an increased risk of blindness to a faster decline in mental function, here are 10 compelling -- and often surprising -- reasons to stick to your commitment.

Alzheimer's Disease: Smoking Speeds Up Mental Decline

SIDS: Maternal Smoking Doubles Risk

Colic: Smoking Makes Babies Irritable, Too

An Increased Risk of Impotence

Blindness: Smoking Raises Risk of Age-Related Macular Degeneration

Rheumatoid Arthritis: Genetically Vulnerable Smokers Increase Their Risk Even More

Snoring: Even Living With a Smoker Raises Risk

Acid Reflux: Heavy Smoking Linked to Heartburn

Breast Cancer: Active Smoking Plays Bigger Role Than Thought

If those top 10 reasons weren't enough to motivate you to quit smoking, keep this in mind:

Smoking is linked to certain colon cancers.

Smoking may increase the risk of depression in young people,

Some studies have linked smoking to thyroid disease.

How Cigarette Smoke Causes Cancer: Study Points To New Treatments, Safer Tobacco (adopted fromScienceDaily (Mar. 2008) —

Everyone has known for decades that that smoking can kill, but until now no one really understood how cigarette smoke causes healthy lung cells to become cancerous. Researchers from the University of California, Davis, show that hydrogen peroxide (or similar oxidants) in cigarette smoke is the culprit. This finding may help the tobacco industry develop "safer" cigarettes by eliminating such substances in the smoke, while giving medical researchers a new avenue to developing lung cancer treatments.

With the five-year survival rate for people with lung cancer at a dismally low 15.5 percent, the study will provide better insight into the identification of new therapeutic targets.

In the research study, researchers describe how they exposed different sets of human lung airway cells (in the laboratory) to cigarette smoke and hydrogen peroxide. After exposure, these cells were then incubated for one to two days. Then they, along with unexposed airway cells, were assessed for signs of cancer development. The cells exposed to cigarettes smoke and the cells exposed to hydrogen peroxide showed the same molecular signatures of cancer development, while the unexposed cells did not.

"Guns kill, bombs kill and cigarettes kill," said Gerald Weissmann, MD, Editor-in-Chief of The FASEB Journal. "While biologists can't do much about the first two, studies like this will help in the fight against tobacco-related death and disease. These experiments not only pin-point new molecular targets for cancer treatment, but also identify culprits in cigarette smoke that eventually will do the smoker in."

According to the U.S. Centers for Disease Control and Prevention, cigarette smoking is the single most preventable cause of premature death in the United States, resulting in more than 400,000 deaths per year or about 1 in 5 U.S. deaths overall. Smoking accounts for the vast majority of lung cancer deaths, causing 90 percent of all lung cancer deaths in men and about 80 percent in women. In 2000, a Surgeon General report revealed that tobacco smoke contains more than 4,000 chemical compounds, with 43 being known carcinogens. Some of the 4,000 compounds result from chemicals added in processing to improve taste, increase burning times, and prolong shelf life.

This research is published in the March 2008 print issue of The FASEB Journal.

Certain Vitamin Supplements May Increase Lung Cancer Risk, Especially In Smokers

Vitamin supplements do not protect against lung cancer, according to a study of more than 77,000 vitamin users. In fact, some supplements may even increase the risk of developing it. A study of supplemental multivitamins, vitamin C, vitamin E and folate did not show any evidence for a decreased risk of lung cancer, wrote the study's author "Indeed, increasing intake of supplemental vitamin E was associated with a slightly increased risk of lung cancer." he said.

Researchers selected a prospective cohort of 77,126 men and women between 50 and 76 years of age in the VITAL (VITamins And Lifestyle) study, and determined their rate of developing lung cancer over four years with respect to their current and past vitamin usage, smoking, and other demographic and medical characteristics.

Of the original cohort, 521 developed lung cancer, the expected rate for a low-risk cohort such as VITAL. But among those who developed lung cancer, in addition to the unsurprising associations with smoking history, family history, and age, there was a slight but significant association between use of supplemental vitamin E and lung cancer.

In contrast to the often assumed benefits or at least lack of harm, supplemental vitamin E was associated with a small increased risk of lung cancer. The increased risk was most prominent in current smokers.

The idea that vitamin supplements are healthy, or at the very least, do no harm, comes from the desire of many people to mimic the benefits of a healthy diet of fruits and vegetables with a convenient pill. However, fruits contain not only vitamins but also many hundreds of other phytochemical compounds whose functions are not well understood.

The World Cancer Research Fund and the American Cancer Society recommend two servings of fruit each day, based on a study that previously found a 20 percent increase in cancer risk among people who ate the least amount of fruit. This recommendation would likely lead to a reduced risk for lung cancer, as well as reduced risk of several other cancers and cardiovascular disease However, any benefit to the population of smokers from increasing fruit intake to reduce cancer risk by 20 percent would be more than offset if even a small proportion of smokers decided to continue tobacco use in favor of such a diet change.

These findings have broad public health implications, given the large population of current and former smokers and the widespread use of vitamin supplements. Future studies may focus on other components of fruits and vegetables that may explain the decreased risk [of cancer] that has been associated with fruits and vegetables.

Big brains payrolled by Big Tobacco

16 February 2008

Jim Giles writing in Magazine issue 2643:

IT IS well known that when the dangers of smoking became increasingly obvious in the 1950s, tobacco companies funded scientific research aimed at downplaying the risks. Now, a little-known strand of that campaign, aimed at giving an intellectual gloss to pro-smoking arguments, has been detailed for the first time.

In an attempt to win hearts and minds, the tobacco companies bankrolled a network of economists, philosophers and sociologists. Documents newly scrutinized by academics reveal that members of the network generated extensive media coverage and numerous academic articles - with almost no mention that the work had been paid for by cigarette manufacturers.

The perverse prosperity of the tobacco industry

Incredibly, the financial health of tobacco companies continues to improve as the physical health of its customers continues to decline. Last week, analysts at the bank, J P Morgan, reported that tobacco had consistently outperformed the US and European market since 1973 and that they saw no reason for this trend to change. And this despite all the assaults against the tobacco industry over the past few decades: first, lawsuits and then the Framework Convention on Tobacco Control (FCTC), WHO's first treaty, which was adopted in 2005 and has been signed by 168 countries to date.

Such attacks on the industry continue thick and fast. In Florida, US tobacco companies were deluged with thousands of new lawsuits before the deadline imposed by the Florida Supreme Court for filing individual claims after last year's decision to overturn a US$145 billion class action punitive award. And the Nigerian Government is currently suing three tobacco companies—British American Tobacco, Philip Morris, and International Tobacco—for $44 billion after accusing them of deliberately promoting smoking to young Nigerians.

The Lancet Chronic Diseases Series showed that 5·5 million deaths could be avoided in 23 countries if the four elements of the FCTC—increased taxes on tobacco products; enforcement of smoke-free work places; packaging, labels, and public awareness campaigns about the health risks of smoking; and a comprehensive ban on tobacco advertising—were implemented.

The Bill & Melinda Gates Foundation has taken a stand against investing in tobacco companies, describing such enterprises as “egregious”. Other investors should follow their example. And WHO should make better use of the most effective weapon it has against the tobacco industry—the FCTC. Countries that have not signed and ratified the FCTC, such as America and Italy, should do so and all member states should make the implementation of the four key elements of the FCTC an urgent priority. Tobacco companies must not be allowed to continue to profit from the massive amount of mortality, morbidity, and misery they cause. We look forward to the time when J P Morgan advises investors to “sell, sell, sell” The Lancet 26 January 2008

Teaming up for tobacco control

Last week, two billionaires—Microsoft founder Bill Gates and New York City mayor Michael Bloomberg—announced their latest plan for spending some of their vast fortunes. The pair, through their respective charitable organisations, the Bill & Melinda Gates Foundation and Bloomberg Philanthropies, will contribute a combined total of US$500 million to global tobacco-control programmes.

This is not the first time that Bloomberg, who led New York City's successful anti-smoking legislation in 2002, has contributed his own money to anti-tobacco efforts. In 2005, he set up Bloomberg's Initiative to Reduce Tobacco Use with $125 million, and his foundation helped fund WHO's Report on the Global Tobacco Epidemic 2008. That report culminated in the MPOWER package, a group of evidence-based strategies for tobacco control. (The acronym stands for: Monitor tobacco use and policies; Protect people from second-hand smoke; Offer help to quit; Warn about the dangers of tobacco; Enforce bans on advertising, promotion, and tobacco company sponsorship; and Raise taxes on tobacco products.) Bloomberg will now make a further donation of $250 million, to be used over 4 years. The Gates' contribution is $125 million over 5 years, of which $24 million is designated as a grant to the Bloomberg Initiative. These investments are modest when set against the net worth of the two funders, but the amount vastly exceeds what is now being spent on tobacco control in low-income and middle-income countries. According to the 2008 WHO report, such spending comes to less than half a penny per person per year—against tobacco tax revenues of nearly $66 million. Read more ...

THE NOSE KNOWS

THE NOSE KNOWS

The stinking fuss about stench in two city barangays (formerly barrio, in Spanish) reminds me of an anecdotal court case whose outcome swung on the testimony of an expert witness. The prosecution witness had a reputed ability to distinguish odors of a wide range of chemicals and substances. He was to identify and pinpoint the source of the foul and obnoxious odors permeating a certain locality.

The wily defense team neutralized the expert’s testimony with simple cunning. Asked to identify two common liquids contained in separate receptacles, the expert sniffed the first substance proffered and promptly identified it as gasoline, but thereafter failed to identify the second. The defense had deadened his sense of smell with the first whiff. Chicanery may win court cases, but firms polluting the air with repulsive vapors emanating from putrid wastes and effluents to save costs cannot mask or neutralize the wafting stink.

Household deodorants being marketed do not really remove odors as ads imply, but merely mask the unwanted odor with a stronger aroma. There are three basic ways to get rid of undesirable odors: masking them with stronger scents, such as the ubiquitous lemon and pine fragrances; chemically dissolving or absorbing them with activated charcoal, baking soda or silica gel; and numbing out the nose. In the past, air-freshener products in the last category used formaldehyde or its solid version, paraformaldehyde, which is known as both poisonous and carcinogenic. The Monsanto company later developed a somewhat less lethal nasal anesthetic (the precise formulation is secret), which has since been incorporated into some air-fresheners along with the usual masking fragrances.

Some firms deny making use of a nasal anesthetic, saying that their products employ a combination of masking fragrances and odor counteractants which is curiously, the similar-sounding term malodor counteractant used in scientific journals, a code word for nasal anesthetic.

SENSE OF SMELL

The sense of smell is a potent means of animal communication. Many animal species emit smell signals called pheromones for luring mates, marking territory, deceiving enemies, or detecting prey and predators.

Compared to animals, humans are poor sniffers. The rabbit has 100 million cells in its nose used for smelling, and German shepherd dogs have 200 million, 44 times the number that humans possess. The intense sniffing ability of dogs (canines or its militarized homophone K-9) is employed by police to sniff and detect contraband drugs and explosives or track fugitives or lost children. A late news item carried the story of Scooby, an ace sniffer dog about to retire. The 7-year-old Labrador was so successful that drug dealers took out a contract on his life and that of his owner.

Late news (March 2008): Wine Taster's Nose Insured for Millions. His schnoz is not to be sniffed at. The nose of leading European winemaker and taster Ilja Gort has been insured for euro5 million ($8 million), Lloyd's of London said. Gort, 47, said his nose is essential for him to produce top quality wines at his Chateau de la Garde vineyard in the famous Bordeaux region of France, so he got it insured. The custom-made policy covers Gort for the loss of either his nose or his sense of smell and has some unusual conditions.

The insurance contract includes a list of what Gort considers "old-fashioned rules" to protect his nose. The Dutchman is not allowed to ride a motorcycle or be a boxer, knife thrower's assistant or a fire-breather. "I may not fight against Mike Tyson," Gort said.

To humans, a chemical compound to possess an odor must pass into the nasal cavity, directly above which are olfactory bulbs with projecting hair (tiny nerve fibers) that receive smell impulses and relay them to the brain. The exact mechanism is not known. One theory is that the aromatic molecules dissolve in the fluid of the cavity lining and bathe the sensory cells. Another is that gas comes into direct contact with the sub-microscopic cell hairs that penetrate the mucous layer.

The ability to smell a particular substance depends on the concentration of its presence in the air. Higher temperatures and moisture intensifies the smell. Thresholds of detection for different substances vary. For example, expressed in milligrams per thousand cubic meters, for a large room of 35,000 cubic feet in volume are:

feces (skatole) is 0.0004,

rotten cabbage (mercaptan) is 0.04,

rancid butter (butyric acid) is 1.0.

Malodorous mercaptan, considered the worst odor ever compounded, was at one time added to cooking gas to give warning of dangerous leaks. This practice was discontinued when odorous liquid petroleum gas (LPG) in cylinders was marketed.

The paucity of odor words in the vocabulary of most languages is obvious when attempting to describe a scent. A redolent thing assumes the bouquet of a flower or fruit, such as jasmine, rose, orange, lemon, apple, vanilla, and vulgar terms for substances reeking obnoxious odors: rotten egg, fishy, flatus.

Though many aromas are described in terms of fruit scent, there is one fruit that defies description with widely divergent and passionate views expressed, ranging from highly appreciative to deep disgust. The durian fruit that grows in Southeast Asia’s equatorial belt, (the Sulu archipelago in the Philippines) has a flavor and aroma that elicits the full spectrum of odor: cream-cheese, onion-sauce, sherry-wine, pig-shit, turpentine and onions garnished with a gym sock, French custard passed through a sewer. These are the kind words. The aroma of the fruit is so powerful it is forbidden in tourist areas and in public transport of many countries.

Odors often attain meanings that noses cannot sense. Fishy means an article or action that is questionable or suspicious. Stink is a public outcry over something offensive. And if something “stinks to high heavens”, the scope of suspicion becomes enormous, blatant, and flagrant.

CHEMISTRY MAGIC

Modern chemistry has made great strides in two fields affecting human lives: in food flavors and in perfumes and aromatics. Analysis of chemical components of the aromatics in foods and botanical fragrances enabled chemists to synthesize chemicals mimicking the scent of practically all flavors and fragrances.

In food labs, essential oils of various foods can be duplicated – alcohols (menthol), aldehydes (cinnamon), esters (lavender), ethers (aniseed), ketones (dill), phenols (cloves). These synthetics are now routinely added to natural products as blend or augmentation, and even to replace entirely as imitation.

The other field of fragrance magic is in perfumes, a word derived from Latin per fumus (through smoke). If wild animals have their pheromones, sophisticated man, or more aptly, alluring woman, has perfume as lure.

The art of perfumery is traced as far back as the pharaohs of ancient Egypt. Its history mentions the scents of Cleopatra, the frankincense and myrrh of the three Magi bringing gifts to the babe in Bethlehem, and both Napoleon and Josephine are known fanciers.

The perfume business has spread to practically all countries as ingredient suppliers or as users of colognes and eau de toilette. A good perfume is said to have 10 to 50 ingredients blended from natural oils, synthetics (aromatic chemicals), and fixatives to bind the mixture. Animal fixatives, whose purpose is to slow down the evaporation of the more volatile oils, includes ambergris from whales, musk from musk deer and civet from wildcats. The fragrance of ylang-ylang is the Philippine contribution, said to be an ingredient of renowned perfumes made by Yves St. Laurent.

There are five standard methods of capturing essences from nature: distillation, expression, maceration, enfleurage, and volatile solvents process. But there are fragrances such as the lily and lilac that cannot successfully be made to yield their natural oils. Modern chemistry intervened, first probing the composition of natural fragrances and eventually compounding substances resembling those of nature. One such chemical was used in a popular brand: Chanel no. 5.

The creation of a good perfume is finally the result of the artistry of a master perfumer blending by trial and error for as long as a year, and adding such ethereal qualities as appeal, taste, originality, and theme.

An amusing story was in the news recently. A cheap imitation fragrance named Viagra, a concoction of ingredients that even its owner does not know, has been sued by the makers of the popular drug with that patented name. Some people just do not accept the saying that imitation is the sincerest form of flattery.

Despite the huge market of fragrances in the food and perfume fields, they share a miniscule one-fifth of total manufacture. Most are used to scent consumer goods such as medicinal ointments and unguents, detergents, and even cars to provide the illusion of freshness.

AROMATHERAPY

Aromatherapy is the practice of using volatile plant oils, including essential oils, for psychological and physical well-being. Perfume oils are not the same as essential oils. Perfume oils and fragrances contain chemicals that do not provide the claimed therapeutic benefits of essential oils.

The modes of application of aromatherapy, predominantly topical applications for general massage, baths, compresses, therapeutic skin care, but also include aerial diffusion for environmental or aerial disinfection, direct inhalation for respiratory disinfection, decongestion, expectoration as well as psychological effects, and

oral, rectal, vaginal interfaces for infection, congestion, parasites, perfumery for body fragrancing, anointments

In the English-speaking world, practitioners tend to emphasize the use of oils in massage, and aromatherapy tends to be regarded as a complementary modality at best and a pseudoscientific fraud at worst.

One of the most comprehensive investigations done to date on aromatherapy failed to show any improvement in either immune status, wound healing or pain control among people exposed to two often-touted scents. While one of two popular aromas touted by alternative medicine practitioners – lemon – (also the favored scent for dishwashing liquid soap and deodorants) did appear to enhance moods positively among study subjects, the other – lavender – had no effect on reported mood, based on three psychological tests.

Neither lemon nor lavender showed any enhancement of the subjects’ immune status, nor did the compounds mitigate either pain or stress, based on a host of biochemical markers.

DOWNWIND OF SKATOLE

A favorite expletive of General “Bull” Schwarkoff (B.S.) of desert Storm fame was “bovine scatology”, abbreviated B.S. (commonly known as bullshit). His use of the term was military parlance, not in reference to odors. But whosoever gets downwind of skatole will surely get the urge to use an equally expressive civilian expression.

I once had a lively discussion with an agent of a food company who was trying to persuade our neighborhood to allow his company to set up shop nearby, on a lot that encroached into an area declared as a residential zone. His plea was based on the non-pollutive quality of the product (a food item) and the unobtrusive nature of the processing (repackaging).

The attempt to dialog was in itself extraordinary, in contrast to the habitual arrogance of firms contemptuous of community sensitivities. After his spiel, I asked a pointed question: if the product is organic and will therefore spoil, and spillage is unavoidable, what assurance can the company give that the sanitation and cleanup procedures will prevent putrification, considering the lack of a nearby public sewer for dumping their waste water? He has not returned with an answer.

The dialog may have averted a potential incompatibility conflict and discord similar to the furor caused in Barangays Gusa and Tablon. It was also a sign that public displeasure over effluvia has made business firms aware that they can no longer thumb their noses at public feelings. For whenever there is aroma waft in the air, be it from dung or lady fair, the nose knows.

WATER, fluid more precious than oil

WATER, fluid more precious than oil

Chemically, water is a nearly universal solvent. Biologically, it is the dominant constituent of living matter. Physically, it is virtually the only common substance that occurs on our planet as gas, liquid and solid and so defines many of the characteristics of our world. A view of Earth’s surface from outer space is not earthen at all but watery.

Yet finding enough water is a difficult and divisive problem for our society. Most of us take water for granted until nature reminds us otherwise. The latest reminder was the delayed onset of the rains in mid-2007 in the northern Philippines that created such anxiety and panic that officials scrambled some planes skyward to cloud-seed salt. It abated the fears but produced little moisture. Nature, in this instance in the form of the seasonal Southwest Monsoon withheld the rain bearing clouds.

A water shortage is a frustrating problem. Decades of cloud-seeding studies in dry locations around the globe have only confirmed that there is very little meteorologists can do when nature stubbornly withholds rain. Those Air Force planes scattering dry ice or silver iodide calms public anxiety but little moisture to wet the earth. Engineers build dams to collect water or levees to contain overflowing river banks but can’t make one drop of water grow into two.

Water sustains life, not only to the human species but also other organisms that cause illness to humans. Water borne diseases, most commonly diarrhea and typhoid, are caused by water contaminated accidentally or by carelessness. Circulating in nature’s hydrologic cycle (cloud-rain-surface or ground water) the fluid is abiotic but is compromised by man-made devices or pollution.

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Clean water plays another role in human health: hygiene.

Q & A:Men are supposed to wash their hands after urination?

A Harvard man and a Yale man are at the urinal. They finish, zip up, then the Harvard man proceeds to the sink to wash his hands, while the Yale man immediately makes for the exit. The Harvard man says, "At Hah-vahd they teach us to wash our hands after we urinate."

The Yale man replies, "At Yale they teach us not to piss on our hands."

Question: why is it customary for males to wash their hands after urination? I bathe daily and wear fresh underpants, so how does my penis get dirty? It's not like I dig a ditch with it. However, my hands might get dirty from daily activities. Is it not more sensible then to wash my hands before touching my clean penis? Is post urination hand washing a throwback to the bad old days, when sex was "dirty" and so, by extension, were sex organs?

Answer: Good joke; common (but stupid) attitude; rank (but important) topic. Some facts:

The purpose of washing is not to get pee off your hands.

No amount of washing will make you clean.

Your boxer-shorts region--from belly button to mid-thigh--is crawling with germs known as coliform bacteria. These bacteria originated in your intestine, and some of them are deadly. Recall the punji stakes, sharpened sticks that the Vietcong concealed point up along trails and daubed with excrement. Stepping on one, you had a good chance of contracting a fatal infection. Similarly, an otherwise not-so-serious gunshot or knife injury could kill you if it perforated the intestine and allowed coliform bacteria to spread around your abdomen.

What you may not know is that washing will not make the coliform bacteria go away. They're holed up in the pores of your skin and nothing short of sandblasting--certainly not your morning shower--is going to get them out. Showering merely gets rid of the ones that have strayed onto the surface. The bacteria won't do much harm if they stay put, but when you urinate your fingers come in contact with Mister P. long enough for the coliform bacteria in your pores to hop aboard. Your fingers subsequently touch lots of other infectible items. If you don't wash your hands with soap and water (soap gets rid of the skin oil that the bacteria stick to). . .

It now dawns on you: jeez, if merely touching my privates is enough to transmit bacteria, it doesn't matter if I pee or not! Urine is actually fairly sterile. There are reports of it being used during wartime in poor countries as a sort of battlefield disinfectant. The lesson to draw from this, however, is not that you can go forth dripping, but rather that just because you didn't pee on your fingers doesn't mean you can skip washing up.

Washing Hands Best

The largest, most comprehensive study ever done comparing the effectiveness of hand hygiene products shows that nothing works better in getting rid of disease-causing viruses than simply washing one’s hands with good old-fashioned soap and water.

Among the viruses soapy hand washing flushes down the drain is the one that causes the common cold. Other removable viruses cause hepatitis A, acute gastroenteritis and a host of other illnesses. A separate key finding was that waterless handwipes only removed roughly 50 percent of bacteria from volunteer subjects’ hands.

"We studied the efficacy of 14 different hand hygiene agents in reducing bacteria and viruses from the hands. No other studies have measured the effectiveness in removing both bacteria and viruses at the same time." said a public health epidemiologist with the University of North Carolina Health Care System and the UNC School of Public Health.

For the first time, too, the UNC researchers tested what happened when people cleaned their hands for only 10 seconds. That represented the average length of time researchers observed busy health-care personnel washing or otherwise disinfecting their hands at work. Previous studies have had people clean their hands for 30 seconds or so, but that’s not what health-care workers usually do in practice, and the study wanted to test the products under realistic conditions.

Anti-microbial agents were best at reducing bacteria on hands, but waterless, alcohol-based agents had variable and sometimes poor effects, becoming less effective after multiple washes. For removing viruses from the hands, physical removal with soap and water was most effective since some viruses are hardy and relatively resistant to disinfection.

A report on the findings appears in the March issue of the American Journal of Infection Control. Authors are professors of medicine and epidemiology at the UNC schools of medicine and public health; a professor of environmental sciences and engineering in public health; and medical technologist. A Duke University biostatistician, helped analyze the data.

"These findings are important because health-care associated infections rank in the top five causes of death, with an estimated 90,000 deaths each year in the United States," the author said. "Hand hygiene agents have been shown to reduce the incidence of health-care associated infections, and a variety of hand hygiene agents are now available with different active ingredients and application methods.

"Our study showed that the anti-microbial hand washing agents were significantly more effective in reducing bacteria than the alcohol-based handrubs and waterless handwipes," he said. "Our study also showed that, at a short exposure time of 10 seconds, all agents with the exception of handwipes demonstrated a 90 percent reduction of bacteria on the hands."

Alcohol-based handrubs were generally ineffective in demonstrating a significant reduction of a relatively resistant virus. While the use of alcohol-based handrubs will continue to be an important infection control measure, it is important to recommend or require traditional hand washing with soap and water throughout each day.

Researchers first had volunteers clean their hands and then contaminated their hands with Serratia marcescens, a harmless bacterium, and MS2 bacteriophage, a virus comparable to, and substituted for, disease-causing organisms. After that, scientists had the subjects clean their hands with various agents and measured how much of the bacteria and virus remained afterwards.

Adapted from materials from University Of North Carolina School Of Medicine.

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At Home

Most studies on hand washing focus on medical and food service workers. But the American Journal of Infection Control focuses on washing hands at home as a way to stop infections from spreading. Several studies show hands are the single most important transmission route for all types of infections.

Even though most people know to wash their hands after using the toilet or handling a diaper, studies suggest many people are still ending up with germs, particularly those spread by feces, on their hands after leaving the bathroom or caring for a baby.

One study looked in homes of infants recently vaccinated against polio. After vaccination, the virus is known to shed in the baby’s feces. Researchers found the virus on 13 percent of bathroom, living room and kitchen surfaces. While the virus from the vaccine didn’t pose a health risk, the study shows how feces-borne viruses can travel through the home.

Another study found that in homes where salmonella cases had been diagnosed, the bacteria were still lurking in toilet bowls three weeks after the outbreak. Water splashing on the toilet seat was a source of contamination.

Doorknobs, bathroom faucets and toilet flush handles are key sources of germ transmission in the home. That’s why people should focus on cleaning such surfaces regularly and always wash hands after touching them. In one study, a volunteer touched a door handle that had been contaminated with a virus. He then shook hands with other volunteers, and further tests showed he had spread the virus to six people.

The study authors note that the timing of hand washing is key. It’s obvious to wash hands after using the toilet, after sneezing or before eating or handling food. Other crucial times for hand washing are after changing a diaper or cleaning up after a pet, or after touching garbage cans, cleaning cloths, cutting boards, dish rags and utensils that may have come into contact with raw food.

While it may be hard to believe that something as simple as regular hand washing can make a difference in your family’s health, consider what happened in Hong Kong during a 2003 outbreak of SARS, a severe and potentially deadly form of viral pneumonia. The outbreak triggered extensive public and community health measures promoting basic hygiene, including regular hand washing. Not only was the SARS outbreak contained, but other cases of respiratory illnesses, including the flu, dropped sharply.

Comments

Sound advice. I would add that we should avoid touching our mouth, nose, and eyes with unwashed hands. If you can’t wash your hands, use a tissue, and make sure the part that touched your hands does not touch your face. — Posted by Jack F. Bukowski, MD, PhD

I would like an answer to the paper towels vs. electric hand dryer controversy. Restrooms with hand dryers all have signs proclaiming that they are the best hygienic choice. However, restrooms with paper towels often have signs explaining how one should first turn off the sink faucets with the towels and then dry the hands. Actually, this makes more sense to me, especially if one also exits the room using the paper towel to open the door. — Posted by Michael Hendler

It is important to emphasize the obvious. Washing hands, beware of toilet handles, door knobs, etc. all apply to every situation outside the home as well. Public restrooms of all sorts, and most particularly in airplanes, the most dangerous place to be in terms of danger of infection (after hospitals , of course). — Posted by Richard Gustafson

I used to work in an office with about twenty other people. One of my co-workers commented on my use of a paper towel to open the bathroom door, teasing me about ‘not trusting’ my co-workers to wash their hands. I just smiled and said, “It’s habit, especially during flu season.” Yes, flu germs are often airborne, but people don’t wash their hands after they blow their noses, cough, or sneeze, and they leave those germs on everything they touch. — Posted by Rowan

… people who sneeze into their hands. I’ve seen many many people who would otherwise consider themselves to be extreme hygienic do this in public - and then proceed to touch everything around them as if nothing has happened. If you don’t have a tissue, spare the rest of us and sneeze into your shirt or jacket sleeve, not your hands! — Posted by Dan Schenck

How to wash one’s hands properly is also very important. In the public washrooms we’re having increasing installation of automatic water taps, soap dispensers using sensors. This is good. However, the provision of air blowers for hands drying means paper towels no longer provided. Users have to find way to pull open the exit door. Perhaps consideration should be given to provision of automatic exit door or simply taking it down if circumstances allow.— Posted by Kevin Shum

Does anyone know the difference in effectiveness in reducing transmission with antibacterial soaps vs. regular soaps? Like my hesitation to use antibiotics quickly, I’ve assumed antibacterial soaps will encourage the presence of more resistant bacterial and thus have avoided using them — but I’d love to know more from any experts on the subject.



From TPP — I’ve written about this topic. there is no difference in effectiveness between handwashing with regular soap or antibacterial soap, although there is a theoretical risk of contributing to bacteria resistance when you use an antibacterial soap product. (The article is reproduced below.)

Germ Fighters May Lead to Hardier Germs

By TARA PARKER-POPE Published: October 30, 2007

Reports of schoolchildren dying from infections with drug-resistant bacteria are enough to send parents on an antimicrobial cleaning frenzy.

But before you start waging your own personal war on single-celled organisms, be warned. Many household and personal cleaners contain ingredients that could make the resistance problem worse.

Today, hundreds of soaps, hand lotions, kitchen cleansers and even toothpastes and mouthwashes include antibacterial agents. One of the most popular is triclosan, which has been used not only in cleaners but also to coat toys, cutting boards, mouse pads, wallpaper and even dog bowls.

The temptation to blanket our families with antibacterial protection has been fueled by scary news reports about a deadly bacteria called CA-MRSA, which stands for community-acquired methicillin-resistant Staphylococcus aureus. Two otherwise healthy children — a seventh grader in Brooklyn and a high school football player in Virginia — died in recent weeks from MRSA infections.

The general advice for avoiding infection is basic hygiene — washing hands or using alcohol-based sanitizers, keeping scrapes covered until healed and refraining from sharing personal items like towels and cosmetics.

But some recent laboratory studies suggest that antibacterial products containing triclosan may not be the best way to stay clean. Instead of wiping out bacteria randomly, the way regular soap or alcohol-based products do, triclosan may inhibit the growth of bacteria in a way that leaves a larger proportion of resistant bacteria behind, according to lab studies at Tufts and Colorado State Universities, among others.

In fairness, none of the research has shown this effect in the real world. In fact, two randomized studies comparing people who used triclosan hand soaps with people who used plain soaps found no evidence that triclosan contributed to bacteria resistance. The soap industry says these results are far more compelling than the controlled lab studies.

But Allison E. Aiello, an assistant professor of epidemiology at the University of Michigan School of Public Health, says the laboratory evidence against triclosan is compelling enough to raise questions about the products. More meaningful, she says, is that several studies show that antibacterial soaps sold to consumers are no better than plain soaps in terms of reducing illness or the count of bacteria left on hands.

“Given that there doesn’t seem to be a benefit, I think it warrants further evaluation,” said Dr. Aiello, whose review article on antibacterial soaps was published last month in the medical journal Clinical Infectious Diseases. “We should be questioning use of these products.”

Soap companies say the worry about triclosan takes the focus away from the real culprit: the abuse of antibiotics and the need for better hygiene in general. “The last thing we want to see is people discouraged from using beneficial hygiene products,” said Brian Sansoni, a spokesman for the Soap and Detergent Association.

In any given colony of bacteria, some portion will often have a natural resistance to antibiotics. The resistant germs might contain genetic variants that give them stronger cell walls, or pumps that allow them to spit the antibiotic back out. They survive the antibiotic onslaught, and with the susceptible bacteria out of the way, naturally resistant strains can thrive. Not only do they multiply, but some can also share their resistance with other bacteria and collect new resistance traits over time.

Natural resistance happens on such a small scale that it is generally not a health worry. But when antibiotics are overused — either by individuals or when farmers add them to animal feed — the effect is amplified. “You’re going to have this exaggerated, snowballing effect of resistant bacteria multiplying all around you,” said Marlene Zuk, a biology professor at the University of California, Riverside, whose book “Riddled With Life” discusses the proliferation of antibacterial cleaners and personal products.

The question about cleaners containing triclosan is whether the agent kills germs randomly or whether it promotes the same selection pressures that can lead to antibiotic resistance. The worry is not that bacteria might become resistant to triclosan. The fear is that the same bacteria that resist triclosan can also resist certain antibiotics. And a handful of lab studies have suggested that triclosan may select for resistant bacteria.

“Here you have a substance that has been widely used in hospital settings and household settings,” said Herbert P. Schweizer, associate director for research at the department of microbiology, immunology and pathology at Colorado State University, who conducted some of the lab studies showing triclosan resistance. “The exposure to this widely used antimicrobial caused emergence of multidrug resistance in laboratory strains.”

That studies of triclosan use haven’t shown a resistance problem in the community doesn’t mean it won’t happen, said Dr. Stuart B. Levy, a microbiology professor at Tufts who is president of the Alliance for Prudent Use of Antibiotics.

“I’m the first to say we haven’t seen a difference yet in the home,” Dr. Levy said. “We know from antibiotic data that if it happens in a lab it will eventually happen outside the lab.”

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.