They say comparisons are odious. Especially for those who lose, and if we talk about dangers to public health, the fight against smoking is the great defeated. Despite being the leading cause of death, with 52,000 deaths in 2017, smoking control policies are not clear and few media report on their effectiveness or alternatives when they do not work. Paradoxically, other examples with less impact on public health such as traffic accidents – with 1,200 victims last year – receive a high level of governmental and media attention.
To analyze the current problems of tobacco, LA RAZÓN, with the collaboration of Philip Morris, convened the "Coffee on Harm Reduction in Smoking", in which Antonio Sierra, Professor of Preventive Medicine and Microbiology and former Health Counselor of the Canary Islands participated. ; Ángel González, professor Emeritus of Chemistry of the Complutense University of Madrid, director of the Department of Lasers and Molecular Beams of the Multidisciplinary Institute of the Complutense University of Madrid; Francisco Zaragozá, Professor of Pharmacology at the University of Alcalá de Henares, and José Miguel Rodríguez González-Moro, Head of the Pneumology Service at the Prince of Asturias University Hospital.
It is true that, due to the new regulations on smoking control and the economic crisis, the number of smokers has fallen. However, this decline has slowed down in our country, where smoking still affects a third of the population, recalls González-Moro. In Spain it seems that, despite the efforts, prevention and cessation policies do not finish giving the expected results. And the need to approach the problem from another perspective that allows the introduction of complementary measures to reduce the number of smokers is becoming increasingly evident.
The problem of smoking is in the smoke. Dr. Zaragozá points out that when smokers light and burn a cigarette, they are exposed to a large quantity of toxic substances produced by combustion, whose levels, Dr. Sierra completes, can be reduced by up to 95%. At present, there are better alternatives available to smokers, such as electronic or tobacco to heat. And to the extent that they are adopted by those who can not or do not want to stop smoking, "we can talk about harm reduction."
In Sweden they have achieved it. There, the availability and use of an alternative to traditional snuff called snus, has contributed to this country has the lowest rate of smokers and lung cancer in men in the world. But Spain is not the Scandinavian country and must seek its own strategies to reduce the damage of smoking, through measures complementary to current ones that, in the opinion of the speakers, have already proved insufficient to tackle the problem.
The final goal is not to eliminate the damage, since it is known that both in smoking and in any epidemic, eradication practically does not exist. Antonio Sierra points out that "the important thing is to work to bring diseases to the minimum possible", and that is how they propose it in the World Health Organization. "Therefore, our strategy in smoking should be to try to reduce the damage to the minimum," says Dr. Sierra. In this way, avoiding initiation into smoking should come first, but when a smoker can not or does not want to stop smoking, alternatives must come into play.
The first step is to reach citizenship, and here it has not yet been given. "Most still do not see the reduction of damage because the information that comes to him is scarce and incomplete despite the evidence we already have," said Dr. Sierra. And there are already results of independent studies that show the potential of these alternatives without smoke (such as electronic cigarettes and smokeless tobacco) to reduce the number of smokers and the damage, consequently. One example is the latest study in smokers with COPD (Chronic Obstructive Pulmonary Disease), which shows that patients who started using the electronic cigarette improved their results. "In the short and medium term, continue to provide nicotine keeps the patient well, but stop providing toxic substances, causes lung function to reduce its fall, reduce the smoker's cough and have fewer exacerbations. And reducing them has become a fundamental objective of the treatment of this disease, "says González-Moro.
However, the best alternative is always to stop smoking. You can, with a lot of willpower, but the reality is that there are many cases in which the patient does not get it. The policies of smoking cessation play a fundamental role, but it is clear that they are not enough and that they are little known. "There is a total disinformation, even I do not know about the Canary Islands.
It is surprising that of the first cause of death we do not know what devices we have to reduce it, "said Sierra.
Smoking implies an addiction whose abandonment requires a treatment that, in Spain, is not funded. "There are patients who come to the clinic with lung diseases that can not stop smoking and you have to offer them detox treatments. However, the effectiveness of these therapies is not high-less than 10% can be maintained abstinent. For this reason, we must take into account all the alternatives for those patients who do not want or can not stop smoking ». In the opinion of González-Moro, it is necessary to "work and develop studies that endorse this type of product", since in Spain the concept of using alternatives that cause less harm to the patient is little known.
Again it is the problem of misinformation, and not only of smokers, but also of the scientific and medical community. In this sense, Ángel González points out that "it is important to disseminate the scientific findings about the alternatives in an informative way and specifically for the knowledge of health specialists and the scientific community that can assess them". In addition, Antonio Sierra does not understand that "the WHO is reluctant to dialogue with the tobacco sector based on a rule of 15 years ago when there was a conflict of interest, while the situation has changed, as this industry has taken the initiative of betting on less harmful products. This conflict today may not be so clear. "
In this way, both the smoker and the scientific and medical community could have accurate information about alternatives to smoking. "There is still a long way for a doctor to recommend these alternatives to a patient with whom everything has already been tried. But if it is not the doctor, soon the patient will come asking for them and there, we will have to comment. And at that point is where I hope that studies appear with which to inform patients, "explained José Miguel Rodríguez González-Moro.
Right now, the reference at an international level is the United Kingdom. There, the Royal College of Physicians has positioned itself by ensuring that strategies to reduce harm in smoking represent a very powerful complement to existing prevention policies. Also recently the Committee of Science and Technology of the British Parliament has published a report that reviews the studies conducted and notes that electronic cigarettes are 95% less harmful and urges the government to implement a regulation based on scientific evidence, said the Dr. Sierra. For him, the scientific support that this document supposes facilitates the work to the rest of countries, like Spain, that accuses a lack of dynamism as far as the reduction of the damage.
In view of the English example, González maintained, and given the seriousness of the situation, "maybe it was time to launch a national commission of multidisciplinary experts." However, the prospects are not promising, as both Medicine and Administration do not show signs of wanting to move forward: "It seems that we have come this far, we have protected the non-smoker with some policies, but now we have smokers," he concluded. González-Moro. Are we going to take another step to offer them these alternatives?