FDA Makes Legal Smoking raised to 21: All countries should raise it and make it uniform

FDA Makes Legal Smoking raised to 21: All countries should raise it and make it uniform

Dr KK Aggarwal

President CMAAO and Past National President IMA

The smoking age is the minimum legal age required to purchase or smoke tobacco products. Most countries have laws that restrict those below a minimum age from legally purchasing tobacco products.

The U.S. Food and Drug Administration has raised the legal smoking age from 18 to 21. As per FDA “On December 20, 2019, the President signed legislation to amend the Federal Food, Drug, and Cosmetic Act, and raise the federal minimum age of sale of tobacco products from 18 to 21 years. It is now illegal for a retailer to sell any tobacco product to anyone under 21.”

 

CMAAO welcome these decision and urges all National Medical Associations to urge their respective governments to follow the same

In India in 2014 The health ministry set up a committee to recommend amendments to the Tobacco Regulation Act which may suggest raising minimum age for smoking from 18 years to 25. But the same was not implemented.

Singapore 19

Thailand 20

India 18

Pakistan 18

Sri Lanka 21

Bangladesh 16

Nepal 18

Malaysia 19

Korea 19 (purchasing age 20)

New Zealand 18

Australia 18

Hong Kong 18

Philippians 18

Taiwan   18

Japan 20

Indonesia 18

Screen your patients for anxiety and depression as a routine

Anxiety and depression are as strong predictors of various diseases such as high blood pressure, heart disease, arthritis, headaches, back pain and stomach upset as are obesity and smoking, according to the new research from the University of California San Francisco published online Dec. 17, 2018 in Health Psychology.

A population-based cohort study in the US analyzed data from more than 15,000 older adults enrolled in the Health and Retirement study over a four-year period and examined the longitudinal associations of anxiety and depression symptoms with onset of self-reported physical health indices. Baseline anxiety and depression were measured and tested as predictors of medical illness including heart disease, stroke, arthritis, high blood pressure, diabetes and cancer and somatic symptoms such as stomach issues, shortness of breath, dizziness, back pain, headache, pain and eyesight issues.

The study found that anxiety and depression not only predicted greater incidence of nearly all medical illnesses and somatic symptoms, they also independently increased risk for most physical health indices assessed. Overall, 16% of study participants had anxiety and depression symptoms, 31% were obese and 14% were current smokers.

·         Those with anxiety and depression symptoms were at 65% higher risk for a heart condition, 64% higher risk for stroke and 50% higher risk for hypertension.

·         Anxiety and depression also predicted greater incidence of most somatic symptoms, including headache, stomach upset, back pain and shortness of breath. Anxious and depressed patients had 161% increased risk of headache.

In a patient of heart disease or hypertension or back pain, for instance, the questions when eliciting history, usually relate to risk factors like smoking, alcohol, unhealthy diet, sedentary life or trauma etc. And, accordingly, lifestyle modifications and/or pharmacological management of risk factors, if present, are advised.

But, this approach may be overlooking two significant factors - anxiety and depression - as this study elucidates. The observed effects of anxiety and depression were found to be as strong as or even more powerful than those of obesity and smoking.

Hence, it is important to routinely screen patients for anxiety and depression. The presenting symptoms may not be just due to a physical illness, but may be due to an underlying mental health disorder such as anxiety and depression.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA

Harm reduction 5: Vaping is not the same as smoking

Dr KK Aggarwal & Dr Rajesh Chawla

Vaping is often considered synonymous with smoking. However, the two are not the same.

Smoking is a practice in which a substance is burned and the resulting smoke breathed is absorbed into the bloodstream. Most commonly, the dried leaves of the tobacco plant which have been rolled into a small square of rice paper to create a small, round cylinder called a "cigarette" are used. Smoking is primarily practiced as a route of administration for recreational drugs use.

Smoke is produced as a result of combustion (temperature > 800 degree C). When combustion occurs, new chemicals are formed via the process of oxidation. Hence, smoke contains thousands of new chemicals different from those initially burned. When a cigarette is smoked, there must be a fire to create the smoke.

Vaping is the act of inhaling and exhaling a vapor or an aerosol. E-cigarettes do not produce tobacco smoke, but an aerosol, which is commonly termed as “vapor” (1, 2).

Vapor: When a substance becomes gaseous, at a temperature that is lower than its point of combustion (180-250 degree C), it is considered as vapor. Unlike smoke, when vapor is produced, no new chemicals are formed. The chemicals that are in vapor are the same as those found in the vaporized substance.

The chemicals that are in a liquid are the same chemicals that are found in the vapor formed from the liquid. For instance, the e-liquid in e-cigarettes includes propylene glycol, food grade flavoring, vegetable glycerin (also called glycerol) and nicotine. All four of these chemicals are FDA approved for human consumption. (3)

Steam inhalation in medicine is also often advised as adjunctive treatment and may help to alleviate symptoms of lung diseases. Steam inhalation is nothing but the inhalation of water vapor.

Aerosol: Unlike vapor, which is simply a substance in gas form, aerosols contain tiny chemical particles. (4) In physics, a vapor is a substance in the gas phase, whereas an aerosol is a suspension of tiny particles of liquid, solid or both within a gas. Aerosol therefore is the state of the intermediate matter between the liquid and the gaseous state. It is composed of particles, which are neither as dispersed as the gas nor as concentrated as that of the liquid.

Nebulizers, both jet and ultrasonic, also produce aerosols from the respective liquid. Depending on the model, nebulizers generate droplets ranging in size from 1 µm to 5 µm.

Inhalation aerosol therapy in medicine uses bronchodilators and steroids as liquid particles suspended for therapeutic purposes.

The main point of difference of importance between smoke and vapor or aerosol is the presence of toxic tar and carbon monoxide in smoke. The smoke particulate matter, minus the water and nicotine, forms the portion of smoke known as tar, which contains most of the mutagenic and carcinogenic agents in tobacco smoke (5).

References

1.    www.centeronaddiction.org/e-cigarettes/recreational-vaping/what-vaping

2.    veppocig.com/pages/difference-between-smoke-and-vapor 

3.    veppocig.com/pages/difference-between-smoke-and-vapor

4.    truthinitiative.org/news/e-cigarettes-facts-stats-and-regulations

5.    de Angelo Calsaverini Leal RC. Inhalation devices: various forms of administration for therapeutic optimization. Open J Asthma. 2017;1(1):037-044.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA

#AskDrKK: Is smoking in young heart patients related with Cocaine use?

#DrKKAnswers: Cocaine smoking and smoking marijuana can cause heart attack in younger people. 

Dr KK Answers: Can smokers have high Hb levels?

Patients who smoke or have significant exposure to secondary smoke or other sources of carbon monoxide may have hematocrits higher than normal  occasionally reaching polycythemic levels.

Doctors should quit smoking

Summary:

Doctors are role model for the society and should not smoke at all and particularly in public. It is also true that even doctors find it hard to quit smoking. The answer therefore is not to start smoking or quitting it as early as possible before it becomes a hard hitting habit, said Padma Shri and Dr. B.C. Roy National Awardee. Dr. KK Aggarwal, President Heart Care Foundation of India.

Text

Even doctors find it hard to quit smoking. Therefore, in the first place, the answer is not to start smoking or quitting as early as possible before it becomes a hard hitting habit.

Doctors are a role model for the society and should not smoke at all and even if they do, it should not be before patients or at social gatherings. A doctor cannot advise quitting smoking if he/she himself/herself smokes.

Most doctors start smoking before they enter medical colleges and continue to do so because of the hardships one goes through during the medical college education. For quitting smoking, these doctors can set an example in the society. It is easier for doctors to quit smoking than patients or general public as counseling a doctor is much easier than a non–doctor. However, doctors cannot counsel themselves and therefore, they need a counselor and help from another doctor.