ASH Daily News for 02 September 2008

Patients with high risk of stroke and heart attack 'ignoring doctors' advice'

Britons at high risk of heart attack and stroke are ignoring doctors' advice to change their lifestyle, says a new survey. More than three-quarters are obese or overweight, with dangerously big stomachs, and most smokers have refused to give up. More than half have out-of-control blood pressure and 40 per cent have high cholesterol levels. Two out of three refuse to accept they are more at risk than other people their age - despite being given warnings and prescription drugs by their GP.

The findings from a major European survey were released today at the European Society for Cardiology congress in Munich. Around one in three middle-aged Britons is at high risk of heart disease because of factors such as obesity, diabetes, family history, high cholesterol and blood pressure levels. This means they have a one in five chance of suffering a fatal heart attack unless they change their lifestyle.

The new survey of 12 countries looked in detail at 381 patients in the UK, who had been diagnosed as 'high risk' at least six months earlier by their GPs. In many cases they were taking medication as a result. Almost 80 per cent of those who were smokers at the time had not given up despite smoking being a major cause of heart disease. Altogether 82 per cent of high risk patients were overweight or obese - half of whom were so fat it threatens their health. Four out of five had a dangerously large waist circumference, indicating deposits of abdominal fat that raise the chances of diabetes and heart problems.

The EUROASPIRE survey showed about two out of five patients said they did not take regular exercise and had no plans to do so. Around half had diabetes, including seven per cent whose condition was detected when they were taking part in the survey and having various tests. In total, 57 per cent of patients had raised blood pressure despite three-quarters of them being on antihypertensive drugs. At least 40 per cent of patients had high blood cholesterol, even though the UK uses more statin drugs – which reduce cholesterol - than any other European country except Italy. Three out of four of those agreed, when they were asked whether everyone should know of their heart disease risk, compared with just 21 per cent in Bulgaria.

But there was an alarming level of ignorance among British patients about their state of health. Altogether two-thirds said they did not think their risk of heart disease was higher than a person in the general population of the same age and sex, including 16 per cent who thought it was lower. Just 33 per cent believed it was higher - as their doctors had told them.

Professor David Wood, an expert in cardiovascular medicine at the National Heart and Lung Institute, Imperial College, London, said the survey raised concerns that many Britons were in denial about their heart health. He said 'These figures are quite shocking. This is high-risk population, diagnosed by their GPs and started on treatment. They should be managed much more rigorously and their lifestyle should be changing. Therapeutic control of their conditions is poorer compared with that achieved by specialists caring for patients with coronary disease.’

He said one in three people aged between 40 and 75 years were at higher risk of heart disease, although many had not been diagnosed. He said European research showed that nurse-led programmes in GP surgeries were the best way to help high-risk heart patients change their lifestyle - and that of their partners. Four out of five families ate more fruit and vegetables when nurses got involved, and the number doing physical activity doubled, he said. 'We have the evidence to back this and we must do better at helping people change their lifestyle and adhere to their medication' he added.

The survey used trained technicians to question 381 patients who had been told they were at high risk of heart disease before developing any symptoms. They were prescribed drugs or being treated with dietary advice. The fact that so few smokers had quit goes against the national trend, with more people giving up since the ban on smoking in public. However, many of these patients in their 40s, 50s and 60s will have been smokers for decades.

Source: The Daily Mail 2nd September,
Link: http://tinyurl.com/6qqxs8

Educator slams tobacco industry for targeting youth market

University of Minnesota Scholar Barbara Loken slammed tobacco companies for deliberately marketing towards youths.

Professor Loken, who co-edited a National Cancer Institute report released August 21st was quoted in a UM press release as saying "There is now incontrovertible evidence that marketing of tobacco, and the depiction of smoking in the movies, promote youth smoking and can cause young people to begin smoking."

The 684-page monograph, "The Role of the Media in Promoting and Reducing Tobacco Use," presents definitive conclusions that a) tobacco advertising and promotion are causally related to increased tobacco use, and b) exposure to depictions of smoking in movies causes youth smoking initiation. The report also concludes that while mass media campaigns can reduce tobacco use, youth smoking prevention campaigns sponsored by the tobacco industry are generally ineffective and may even increase youth smoking.

"The role of marketing in the success of the tobacco companies is conclusive," according to Loken. "The report's recommendations offer the best approach to employ marketing techniques and the media to help prevent a further increase in youth smoking."

The NCI report reaches six major conclusions:

Cigarettes are one of the most heavily marketed products in the United States.

Tobacco advertising targets psychological needs of adolescents, such as popularity and peer acceptance. Advertising creates the perception that smoking satisfies these needs.

Even brief exposure to tobacco advertising influences adolescents' perceptions about smoking, smokers, and adolescents' intentions to smoke.

The depiction of cigarette smoking is pervasive in movies, occurring in 75 percent or more of contemporary box-office hits, with identifiable brands in about one-third of movies.

A comprehensive ban on tobacco advertising and promotion is an effective policy intervention that prevents tobacco companies from shifting marketing expenditures to permitted media.

The tobacco industry works hard to impede tobacco control media campaigns, including attempts to prevent or reduce their funding. "This direct link between marketing and tobacco use is very powerful." Loken said, "Anti-tobacco ads before films and a comprehensive ban on tobacco advertising are two effective strategies found to curb effects of tobacco images on youth. Now we need to use marketing to steer youth and others away from tobacco."

Source: Axcess News 2nd September, 2008
Link: http://tinyurl.com/636bx4

India: Tobacco - Need for effective regulation

The most important thing is to ban all forms of tobacco consumption in public places.

By now, it is well established that tobacco is the single-most important contributor to non-communicable diseases in India. India has the second-largest number of tobacco consumers. Almost 10 per cent of the world’s tobacco consumers numbering 120 million are Indians. Interestingly, unlike in the west, 85 per cent of this is non-cigarette consumption in the form of bidis, chewing tobacco and paan.

With acceleration in economic growth and in keeping with significant increase in disposable incomes, tobacco consumption in India has shown a sharp increase in recent years. Not surprisingly, cigarette manufacturers from industrialised countries are strategically shifting their markets to emerging economies like India. At the same time, there is a growing realisation in civil society, the media and the government of the need to control the spread of the tobacco epidemic by enforcing regulations and making people aware of the mortality consequences of tobacco consumption. At the same time, the tobacco economy involves millions of workers who are directly or indirectly involved in farming, manufacturing and trade. Finding alternative sources of employment and incomes for these people must be a part of the action plan in curtailing the consumption of tobacco.

Evidence from the National Family Health Survey (NFHS-3) in India shows that 57 per cent of men and 11 per cent of women aged 15-49 consume one form of tobacco or another. Tobacco chewing is the most prevalent form of consumption in India. About 33 per cent of men and 8 per cent of women in India chew tobacco in the form of paan masala and gutka. However, smoking is largely a male habit. While nearly one-third of all men smoked either cigarettes or bidis or both, the share of women smoking is just about 1 per cent. While bidis have a larger share of the market in rural areas, cigarette smoking is largely an urban phenomenon.

According to the World Health Organisation, globally 5.4 million deaths are associated with tobacco every year and it is anticipated that by 2030, 80 per cent of these deaths will be in developing countries. According to Prabhat Jha, in India around a million deaths will be attributed to smoking by the early 2010s. What is worrying, it is already a major cause of death among Indians aged 30-69, an economically productive age group and 20 per cent of all male deaths and 5 per cent of female deaths are caused by smoking alone. The leading causes of death from smoking are cardiovascular diseases, chronic obstructive pulmonary disease and lung cancer. Dr Srinath Reddy of the Public Health Foundation of India estimates that almost Rs 3,000 crore is spent on the treatment of tobacco-related diseases every year, which is about a fourth of all health spending in the country.

Studies have shown that on average, male bidi smokers lose roughly six years of life, female bidi smokers about eight years and male cigarette smokers about 10 years. Smokers in rural areas are more likely to die of tuberculosis while in urban India death is due to cardiovascular diseases. Further, estimates show that over a half of deaths due to tobacco smoking occur among illiterates and roughly 80 per cent are found to be from rural areas. Furthermore, cohort studies have found that in rural India, the relative risk of death due to tobacco use is 40-80 per cent higher for any type of tobacco use. In urban areas, studies in Mumbai have found that smokers had a 50 per cent higher risk of death and other tobacco consumers have a 15 per cent higher risk of death.

Given that the consumption of tobacco entails a variety of costs beyond the perception of an average smoker, it is appropriate that its consumption should be regulated. In India, although tobacco-control policy and legislation was initiated in the mid-1970s, much remains to be done to make it effective. The Indian government and civil society have made substantial progress in tobacco control, but there are considerable lags in implementation and in educating the younger generations on the hazards of tobacco use, particularly in rural areas.

Taxation has been one of the most effective ways of regulating the consumption of tobacco in most countries. In India, the Centre imposes excise duties including special excise duties and an additional surcharge for the National Calamity Contingency Fund on the manufacture of tobacco products. Since 2005-06, there is a levy of additional duties on pan masala and other tobacco products to partly fund the National Rural Health Mission. There is also a bidi workers’ welfare cess levied only on bidis, at the rate of Rs 4 per 1,000 sticks. Further, as part of a tax rental agreement, the states had transferred their powers to levy sales tax on tobacco to the Centre and since 1957 the latter has been collecting additional excise duties, and the revenue from the levy is transferred to the states. Under these regimes, tobacco products other than cigarettes and bidis are taxed on an ad valorem basis. Cigarettes of various lengths are taxed at different specific rates, by the Centre. However, the tax burden on the unorganised sector is negligible.

There are difficulties in regulating the consumption of tobacco products through tax policy because over 80 per cent of tobacco consumption is in the unorganised sector. Bidi is a widely dispersed cottage industry and so are products like gutka, snuff and chewing tobacco. While the states want to have tax powers to raise revenues, very little effort is put in to use the instrument to regulate consumption. Indeed, given the dispersed and unorganised nature of the production of tobacco products, it may be worthwhile to levy the tax at the stage of sale of tobacco and again when the tobacco products are sold. The states should redouble their efforts at extending the tax to unorganised tobacco products.

The most important regulation is to enforce the ban on smoking as well as other forms of tobacco consumption in public places. Similarly, significant additional effort is needed to educate the public on the health hazards and create an organised campaign against the consumption of not only cigarettes but also other tobacco products. It is also important to extend taxation to all tobacco products.

Source: Business Standard (New Delhi), 2nd September 2008
Link: http://tinyurl.com/5vbutk