Doctors of the World Unite!
Neurologists join Oncologists to call for tobacco ban in Singapore.
Oct 6, 2005
No reason to wait 10 years to ban smoking
IT WAS with great interest that we read about cancer specialists from a group of Asian countries calling for a ban on tobacco within the next 10 years ('Singapore cancer specialists to push for tobacco ban'; ST, Sept 22).
Among the many diseases causally linked with cigarette smoking is stroke. Stroke is Singapore's fourth leading cause of death, and the leading cause of adult neurologic disability. Up to 25 per cent of all strokes are directly attributable to cigarette smoking. Data from Singapore hospitals shows that 25 per cent of patients admitted to hospital admitted to being smokers.
Current research shows that the risk of stroke among smokers compared to non-smokers is increased by 1.5 times for stroke due to blockage of brain blood vessels (atherothrombotic stroke), two times for stroke due to bleeding into the brain (intraparenchymal haemorrhage), and three times for stroke due to bursting of a bubble on a brain vessel (aneurysmal subarachnoid haemorrhage), to even four times among female heavy smokers.
Environmental tobacco smoke - that is, passive smoking - puts additional, innocent lives at risk of major diseases.
Stroke is an expensive disease to treat. Hospital bills for stroke in Singapore average $7,500 a patient, rising to $29,000 for subarachnoid haemorrhage.
Additional costs for the lifetime of the patients, especially for the more disabled survivors, include outpatient medication and rehabilitation, loss of income, home help (e.g., maid), disability aids (e.g., wheelchairs, bedside commodes) and medical supplies (e.g., diapers, milk feeds).
Societal costs include absence from work and workforce attrition from premature death and disability of previously able-bodied Singaporeans.
With approximately 10,000 admissions to Singapore hospitals for stroke and related disorders every year, the total cost of this disease to Singapore would run into the millions.
While a part of the cost may be offset by duties on cigarette imports, it is largely borne by the stroke patient, the family, and the taxpayer.
Stopping smoking reduces the risk of stroke significantly within five years. The risk of a light smoker returns to that of a non-smoker, while that of a heavy smoker (more than 20 cigarettes a day) is certainly reduced, but does remain above that of a non-smoker.
Without any clear evidence of benefit from cigarette smoking that would outweigh its many risks, there is little to support its continuance. We, too, support the call for its total ban in Singapore, to run concurrent with further support for programmes to help smokers quit.
If chewing gum, which neither kills nor disables, can be banned practically overnight, we see little reason to wait 10 years to ban cigarette smoking in Singapore.
Dr N. V. Ramani
Senior Consultant Neurologist
Clinical Coordinator (Stroke Programme)
National Neuroscience Institute
A/Prof Lee Wei Ling
Director and Senior Consultant Neurologist
National Neuroscience Institute
How long before the cardiologists and respiratory physicians join in?
Imagine all the reductions in cancer, stroke, heart attack, and COPD cases...
Doctors of the World, Unite! We have nothing to lose but our jobs!