"Fire at one end and fool at the other", was how this cylindrical contraption was defined much before the health warning was made mandatory on cigarette packs. Christopher Columbus found the natives using tobacco in much the same way as it is used today, and being led to believe in its possible medicinal value, it was carried to France, Spain, Europe and the rest of the world, wherever colonies were established. Grown in more than 120 countries today, China leads, followed by the USA, India, Brazil and Turkey.
Tobacco belongs to the night shade family Solanaceae, and the genus, Nicotiana was named after Jean Nicot, French Ambassador to Portugal (1559-1561). Many varieties developed subsequently and a South American variety N. Tabacum is the major source of today’s commercial varieties. Nicotine and other alkaloids which are nitrogen containing organic compounds are recognised as habit forming. The seeds are extremely tiny, one tablespoon can easily grow enough seedlings in 6 acres and harvesting takes place between 70-130 days after transplanting. After a process called ‘curing’ (wilting, yellowing, colouring and drying), it is ready. James A Bonsack in the US patented a machine in 1880 in which cigarette paper was filled with tobacco, formed, pasted, and cut into proper length by a rotary machine. Today it is a multimillion dollar industry, more than 7 million tons of tobacco are produced annually and more than 4 trillion cigarettes sold yearly. Nearer home it occupies prime spot through hoardings at traffic intersections. The industry owns luxury hotels, sponsors sports events and advertises it as the icon of the macho male whom the woman seeks! Today thanks to ceaseless efforts by the transnational tobacco conglomerates, production, distribution and marketing of cigarettes continues to grow. Cigarette advertisements continued in the pages of the ‘Journal of the American Medical Association’ until 1954, and even the American Cancer Society (ACS) has been cautious and conservative in challenging its $390 million annual tobacco industry!

The Health Hazard
Of the 676,000 annual newly diagnosed cases of lung cancer in men worldwide, 85% is attributable to cigarette smoking, and compared to men, women have a higher risk of developing cancer, and although the diagnostic and treatment measures have greatly improved alongside the understanding of smoking-related cancers, the risk is still dependent on the extent of exposure to tobacco smoke. Cigarette smoking is a major cause of cancer of the larynx, approximately 80% directly attributable to smoking, and a similar risk exists in those who smoke pipes or cigars, thus it is imperative to explode a myth! Regarding oral cancers a dose relation exists between the number of cigarettes smoked per day and cancers of the lip, tongue, salivary gland, floor of mouth, and hypopharynx, esophagus. Tobacco in its varied forms is responsible for 90% of cancers of the oral cavity. In 1992 the National Cancer Institute (NCI) of the US through a population based case-control study confirmed that cigarette smoking is a major cause of cancers of the renal pelvis, ureters, bladder and prostate. A case-control study of stomach cancer in Japan suggests that cigarette smoking plays a significant role in its causation. The strength and consistency of association of pancreative, colonic cancer, in smokers, and the epidemiological association between smoking and lymphoid and myeloid leukemia have resulted in identifying tobacco metabolites in bile and blood as the causative agents.
In the eighties smoking caused approximately 315000 deaths yearly in the US, which is greater than all the drug and alcohol and drug-abuse deaths, seven times more than automobile fatalities, and more than all American military fatalities of both the World Wars, and Vietnam combined! China, the largest producer of tobacco, is also the largest consumer. Smoking in the US is declining marginally, but the tobacco produced in the US finds its way elsewhere. In fact tobacco moghuls there have the clout to the extent that exports of various commodities from countries like Taiwan, Korea, Philippines etc. are linked to the import to these countries of the US brand of cigarettes.

Urge and Scourge - Why?
"Smoking relieves stress" - the stress that is relieved is that which resulted from being dependent on nicotine - the essence of addiction. Sales gimmicks are responsible for propagating the lure. Every documented report of health hazard has been countered by the promoters. Virginia Slims advertised that smoking keeps you slim and trim, aiming at the female clientele. Advertising strategies succeeded in boosting target sales in the US through catchy slogans. India never lagged behind in advertisement strategy.
Brands with purportedly low levels of tar and nicotine were promoted to calm widespread fears of lung cancer development from smoking when the first medical reports were published in 1964. Tar is a composite of more than 4000 solid products of combustion, containing nearly 40 known carcinogens. Similar adverse reports were offset by the introduction of the filtered brands with risk reducing claims. Of late considerable resources have been invested by tobacco companies in the development of cigarette prototypes in which tobacco is not burned, instead heated so as to provide with nicotine and flavour.

Passive Smoking
Documented reports suggest that two-thirds of smoke from a burning cigarette never reach the smoker’s lungs but instead go directly into the air. Environment tobacco smoke (ETS) also called ‘second-hand smoke’ is defined as the combination of sidestream smoke emitted thus from a cigarette between puffs and the fraction of mainstream smoke exhaled by one who smokes. Considerable evidence is available to the effect that nonsmokers absorb and metabolise significant amounts of ‘second-hand smoke’ and even reports of possible increased relative risks of lung cancer and other diseases in the nonsmoker are available.

Cessation Strategies
Around three hundred cessation strategies have been reported, from group therapy and hypnosis to over-the-counter pharmaceutical products either containing nicotine analogues or aversive chemicals. The Physicians’ active involvement is vital of course. From pack-year history, today the metaphor is the ‘inhalation count’. To put it this way, a pack-a-day smoking patient will breathe as many as one million doses of cyanide, ammonia, carcinogens and carbonmo-noxide in less than 15 years, not including the inhalation of other people’s smoke.

Personalised approaches from all health care givers and individualisation of such messages is the cornerstone of success. Prevention nevertheless is better than cure, and like charity which has to begin at home, let all who have anything at all to do with health, stay away from tobacco.

Urgent versus Important
It is not enough that our country bans cigarette advertisement in televisions or the cigarette pack carry the ‘health warning’. Common myths have to be debunked, that smoking relaxes you, relieves stress and so on. The fact that smoking causes cancer has to be impressed upon through positive strongly worded strategies through the media, be it radio or television. The life of an Indian is as important or more so, than the Indian tiger or our ecology, which seem to be a matter of priority, more to the powers that be. Appropriate measures to limit tobacco sales should be undertaken. Smoking should be banned in public places, much less in government offices and institutions. The right to smoke should not infringe upon the right of those who desire a smoke free environment. Breach of freedom is a crime and therefore through appropriate legislation smoking which violates an adopted code of conduct should be made punishable. "Knowledge puffeth off but wisdom lingereth".

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