The more than 16 million Filipino smokers deserve cigarette alternatives that will help significantly reduce health risks, according to a leading Filipino heart expert.
Dr. Rafael R. Castillo, the first Filipino and Southeast Asian to be elected as a trustee of the United Kingdom-based International Society of Hypertension (ISH), said in a recent satellite symposium during the annual convention of the Philippine Heart Association (PHA) that smokers deserve a viable alternative that can wean them off cigarette smoking, and help them eventually quit.
He said the smoking problem is a serious challenge that is worse than the Covid pandemic. “Smoking is also the number one risk factor for cancer in the Philippines. Smoking is a serial killer that kills so many people,” he added.
Dr. Castillo said that for recalcitrant smokers or those who can’t quit despite smoking cessation interventions, “the use of electronic nicotine delivery systems or alternative tobacco products may serve as a pragmatic middle ground to reduce harm and eventually make them quit completely.”
“With all the heartbreaking failures we had in making recalcitrant smokers kick the habit, we have to face reality. We have to offer recalcitrant smokers alternatives and give them more tools. Smoking addiction is not something that they cannot simply overcome. We have tried all sorts of smoking cessation interventions (nicotine patches, gums, lozenges etc.), but we are not getting anywhere. We are not really progressing as much as we would like to,” he said in a virtual discussion during the 70th anniversary and 52nd annual convention and scientific meeting of PHA.
The Philippines has the second highest prevalence of smoking in Southeast Asia, next to Indonesia, he said. “While cardiovascular diseases are the leading cause of death in the Southeast Asian region, causing more than 1 in four deaths (3.96 million deaths or 29 percent of all deaths), tobacco is the leading preventable risk factor causing the largest number of deaths in the region—more than 1 in 10 deaths (1.51 million or 11.6 percent of all deaths),” he said.
Dr. Castillo, the past president of the Philippine Heart Association-Philippine College of Cardiology and the Asia Pacific Society of Hypertension, said addressing the smoking problem requires a pragmatic approach, as the decline in smoking rate has been slow under the current strategy that involves the use of nicotine replacement therapy.
He said smoke-free nicotine products such as vapes and heated tobacco products (HTPs) can significantly reduce the health risks faced by millions of Filipino smokers. “Nicotine can also be part of the solution to the smoking problem, and it can be part of any intervention that we wish to use to reduce the harm from smoking,” he said.
Dr. Castillo denied that nicotine is the primary cause of smoking-related diseases. “Tobacco smoke contains 7,000 chemicals, of which nicotine is one. Smokers commonly misperceive that nicotine is a major carcinogen. Currently available evidence does not suggest that nicotine in itself induces cancer,” he said.
Nicotine, being the substance that causes addiction, should also play a crucial role in tobacco harm reduction. “Nicotine is the core of the problem, but also the centerpiece of the solution,” he said.
Dr. Castillo said that while complete smoking cessation remains the primary goal, “we have to face the reality that we cannot achieve that. At best after one year of specialist support and drug treatment, successful quit rate is only 20 percent. So at best, you only achieve a 20-percent successful quit rate,” he said.
“Our quit rate is not that encouraging. Worldwide, the quit rate is really very low. At best, in countries with very aggressive intervention, it is only 20 percent in a one-year time. It is not good enough. That is why we believe that offering them alternative products which can wean them from smoking would be our best bet at the moment,” he said.
While traditional approaches have failed to address the smoking epidemic, the introduction of smoke-free alternatives has been associated with less health risks, making them the most effective solution to address the problem, he said.
“While the use of alternative tobacco products does not completely eliminate the harm, they can significantly reduce or mitigate the health risks. Personally, I believe that this is the best bet of all currently available smoking cessation measures to help recalcitrant smokers really kick the smoking problem, not only in our country but worldwide,” he said.
Dr. Castillo said that as part of their due diligence to decide whether to allow alternative tobacco products in their smoking patients or not, their research group at the FAME Leaders Academy conducted a systematic review and meta-analysis on the effects of heated tobacco products compared to traditional tobacco cigarettes on heart rate, blood pressure, and other predictors of cardiovascular risks among adult smokers. Their study showed significant differences in some risk factors that may impact favorably on the smokers’ cardiovascular health.
HTPs and other alternative tobacco products can be part of tobacco harm reduction which is anchored on the fact that there are some lifestyle practices or bad behaviors that are simply inevitable, he said.
“If that is so, our next objective is to minimize the harm people suffer as a consequence. People make poor lifestyle choices despite suffering negative health effects. Complete smoking cessation is the primary goal, but it is not achievable. There has to be a pragmatic middle ground. There will still be around one billion smokers globally by 2025 if the smoking problem is not aggressively addressed,” he said.
Dr. Castillo said a 2019 UK study showed that e-cigarettes proved more effective than nicotine replacement therapy in making smokers quit. “The results concluded that e-cigarettes were more effective for smoking cessation than nicotine replacement therapy, when both products were accompanied by behavioral support,” he said.
Dr. Jorge A. Sison, who moderated the PHA forum, said that while smoking prevalence in the Philippines went down to 25 percent last year from 27 percent in the previous years, the ratio remains high.
Dr. Sison, past president of PHA, said tobacco harm reduction is a promising strategy. “I hope that our government will open its eyes and welcome new addition to our campaign against smoking,” he said.