Researchers in Pakistan will embark on a 600-person study this year to assess smoking cessation methods. The clinical trial, set to run for 48 weeks, will give:
- 200 subjects nicotine pouches
- 200 subjects e-cigarettes
- 200 subjects basic care counselling for 48 weeks
The researchers hope to establish which method is most effective, with “results anticipated to inform the public, decision-makers, and researchers about the effects of using e-cigarettes and nicotine pouches in the short- and medium-term periods.”
The smoking situation in Pakistan
This alternative nicotine product trial is much needed. The authors suggest that over the last five years, innovative tobacco harm-reduction products have been imported into the market in Pakistan. However, so far, uptake has been limited.
Pakistan has a population of around 230 million people. Research suggests that the smoking prevalence rate is around 20%. These figures are heavily skewed toward males in the county and particularly people from lower socio-economic urban settings.
While numbers have been dropping over the last decade, they are still worryingly high, as evidenced by the graphic below that shows male smoking prevalence in Pakistan at over 30%.
Perhaps the most sobering statistic of all is that smoking causes 166,000 deaths each year in Pakistan, more than 10% of all deaths in the country. According to the World Health Organization, these startling figures are set to persist in the region “despite health warnings, cessation campaigns, and increased tobacco control measures.”
As the authors of the clinical trial point out, “The majority of the world’s 1.3 billion tobacco smokers reside in low- and middle-income nations “where the burden of smoking-related disease and mortality is greatest”. As a result, smoking plays a considerable role in health disparities.”
Despite taking its lead from the WHO FCTC, smoking rates are stubbornly high. While the Puritans and ideologues will suggest it’s just a matter of willpower, it’s clear that the existing WHO approach is not having the desired impact.
The bodies are piling up. It’s time to try a more pragmatic approach that is based on real-world results seen in other regions. However, there are barriers to helping people who smoke transition to low-risk nicotine products, not least from some members of the Pakistan medical community.
Barriers to smoking cessation in Pakistan
Previous research by the same authors, Abdul Hameed and Daud Malik, called Public Health Practitioners' Knowledge towards Nicotine and Other Cigarette Components on Various Human Diseases in Pakistan: A Contribution to Smoking Cessation Policies, lays bare the scale of the challenge.
In the 2022 paper, they share the disturbing finding that “more than two-thirds of doctors (70%) strongly agreed and 17.9% somewhat agreed with the statement that nicotine causes cancer.”
If medical professionals are so in the dark about nicotine, what chance does the public have to stay informed about their health choices?
Two graphs from the above paper demonstrate the misconceptions of health professionals about the alternative nicotine products that could reduce Pakistan’s smoking prevalence and death rates.
Yes, you’re reading that correctly: almost 50% of Pakistani doctors believe e-cigarettes are as or more risky than smoking. These dismal figures are the dark legacy of the Tobacco Control misinformation machine and a gullible media who promote their nonsense without a second’s thought.
Final thoughts
Availability of alternative nicotine products in Pakistan is low and mainly clustered around higher-income urban centres. A trial set to take place this year hopes to explore the potential of using alternative nicotine products (e-cigarettes and nicotine pouches) as smoking cessation aids.
The results should help inform smoking policy in the region and, in time, help reduce both smoking rates and deaths. However, much depends on deprogramming the medical professionals who have been misled about the risks of alternative nicotine products.
