Solutions to improve the nation's health presented at SPIEF
Experts are again focusing on the task of population health preservation. Within the framework of this topic, with the support of the Association for Risk Factor Modification (AHRM), a SPIEF session was held, where representatives of the business, medical and scientific communities took part in the discussion. During the event, experts discussed the main aspects of tobacco control as the main avoidable cause of chronic non-communicable diseases (CNCDs) and urged to look for smart solutions for the health of Russians."Today, chronic non-communicable diseases account for up to 71% of all deaths in the world," said Dr. Olga Tkacheva, chief freelance geriatrician of the Ministry of Health of Russia. - We have learned how to treat our patients, prescribe drugs, but we forget about the existence of more effective measures - in particular, about modifying risk factors and prevention.
But convincing a patient to give up a bad habit can be difficult. To solve this problem, the specialist suggested looking for more flexible strategies.
Professor David Zaridze, President of Anticancer Society of Russia, M.D., also supported the idea of flexible approaches. According to him, for the first time the concept of harm reduction in regulatory practice was used in the USSR - based on the results of research, the Ministry of Health regulated the tar content in cigarettes.
In the Soviet Union and then in Russia, the prevalence of smoking actually increased from 1965 to 2009, he said. At the same time, beginning in 1993, the incidence of lung cancer began to decrease, as well as the mortality rate from it. "This happened because in the early 1990s, together with our colleagues, we succeeded in regulating the tar content in cigarettes, thereby reducing its level by half, from 30 to 15 mg," Zaridze added. - It was a huge "jump" from a very high concentration of tar to the international level. - It was a watershed moment: between 1993 and 2013, lung cancer morbidity and mortality decreased, and in men, the standardized lung cancer mortality rate decreased from 73 to 45 cases per 100,000 population. That is, by about 40 percent. Without spending a penny, we saved over 500,000 people from death. This is our domestic example, which speaks to the effectiveness of the concept of harm reduction.
The main point in reducing cancer mortality, according to Zaridze, is prevention and, first and foremost, smoking control. According to the WHO International Classification of Diseases, nicotine addiction is a disease. "However, no nicotine replacement therapy, will lead to success if a professional psychologist does not work with the patient," he emphasized. At the same time, if nicotine replacement therapy does not work, the professor admits switching to alternative nicotine delivery systems, because the content of carcinogens and toxicants in them is much lower than in conventional cigarettes, so their consumption results in the human body significantly less harmful substances released in the process of burning tobacco. "The main thing is for the patient to quit smoking," David Zaridze summarized.
"In 2013, the Russian authorities took quite tough anti-tobacco measures, but VTsIOM data show that for several years the number of smokers in Russia has stood at the same level," said Sergey Katasonov, co-chair of the State Duma expert council and chairman of the committee on nicotine-containing products. - We are "frozen" at the rate of 33%, and it is safe to say that the directive measures have completely exhausted themselves.
According to him, the fight against tobacco smoking often does not take into account neither the sad experience of anti alcohol campaign, nor the results of international studies confirming the effectiveness of alternative nicotine-containing products for smokers with strong nicotine addiction, who are not motivated to quit smoking. "If we continue to pursue a prohibitionist policy, it is very likely that the response will be backlash," he said. Authorities, scientists, and physicians should be encouraged to engage in dialogue so that they can work together to agree on sensible approaches to tobacco regulation.
Ayrat Farrakhov, the deputy of the State Duma, gave a justification of introduction of more flexible measures from the economic point of view. The annual losses of our country from non-communicable diseases amount to 3.6 trillion rubles," he said. - This is the equivalent of all expenditures of the Compulsory Medical Insurance Fund. This once again emphasizes the need to look for effective solutions based on scientific evidence, modern technologies and comprehensive risk modification practices, which will help to reduce the harm to human health and become a real tool for doctors in their work with smoking patients". According to Deputy Farrakhov, the guiding principle in tobacco control should not be the stigmatization of smokers, but rather smart solutions that will achieve national health goals. "Smarter solutions do not appear to be bans and restrictions, but a focus on scientific evidence and modern technology," he clarified.
The magnitude of the tobacco smoking problem is enormous. "30 million of our citizens are active smokers, not to mention passive smokers, so this problem cannot be solved by restrictive measures alone," said Alexander Filippov, professor of the Department of Hospital Therapy of the Medical Faculty of St. Petersburg State University. - If for various reasons we cannot completely eliminate such a serious risk factor as smoking, it is reasonable to modify it. - Tobacco addiction is the most aggressive of all behavioral risk factors. Smoke-free technology is the very tool that allows us to remove the main elements of this risk, although it is not completely eliminated.
The specialist pointed to data of the Royal College of General Practitioners (Great Britain), according to which "there is evidence that the health risk posed by smokeless technologies does not exceed 5% of the harm from tobacco smoking and 0.5% of the lifetime risk of developing cancer". In Filippov's opinion, new strategies are necessary from both state and professional medical communities, while the consumer must receive accurate information about existing alternatives solely on the basis of current scientific research.
According to the panelists - scientists, doctors and government representatives - it is necessary to consider the concept of harm reduction as the most important strategy for reducing the health effects caused by tobacco and to call for independent evaluation of alternative nicotine-containing products by initiating new foreign and domestic research.