Malaysia: Reducing the harm of tobacco for real

Once upon a time, menthol cigarettes were regularly (but falsely) marketed by its makers as a less harsh and less harmful alternative to “normal” cigarettes.

Menthol is a compound that has a minty cooling effect when added to cigarettes.

It also has the additional advantage of blocking pain receptors in the mouth and throat.

Instead of being less harmful, menthol masked the bad taste of cigarettes, which actually resulting in individuals taking deeper breaths while smoking cigarettes.

Ultimately, it has been independently demonstrated that menthol cigarettes are not less harmful.

In fact, it plays a major role in the more than eight million people who are killed by tobacco every year, of which more than a million are non-smokers exposed to second-hand smoke.

In some ways, it is actually worse.

Menthol is added to make cigarettes appear more palatable, ma- king it more appealing to new smokers, especially the young.

There are many studies showing how marketing for menthol cigarettes targets women, youth, ethnic minorities and low-income populations.

In fact, the United Kingdom banned the sale of menthol cigarettes, menthol filters and papers, and “skinny” cigarettes last year in an effort to stop youth from smoking.

Heated tobacco products

More recently, some tobacco companies are promoting the “less harmful” effects of heated tobacco products (HTPs).

These products heat up tobacco using electronic heating elements, releasing aerosol that is inhaled by the user (in contrast to the usual practice of burning tobacco and inhaling the smoke through a filter).

The lack of combustion ostensibly leads to a drop in health complications.

HTPs have also been promoted as a tool to help individuals quit smoking.

However, they still contain chemicals that are toxic and carcinogenic.

These chemicals lead to high numbers of preventable diseases, such as lung cancer, strokes, heart disease and emphysema.

The presence of nicotine – one of the most addictive substances known – ensures that its user remains hooked on the device without any clear pathway towards smoking cessation.

Indeed, there is no scientific evidence to suggest that HTPs are able to help smokers quit.

Controlling tobacco use

The concept of harm reduction is not new to public health.

For example, we use methadone and needle-exchange programmes to reduce the harm from intravenous drug abuse.

The idea is to substitute one harmful vice with another, but it is usually within a controlled environment with a clear endgame in sight.

This concept is sabotaged by tobacco lobbyists who are willing to place profit before lives.

Despite the lack of clear evidence, there are those who are so adamant on the “harm reduction” concept of HTPs that they have pushed for HTPs to be openly advertised, to be used without restriction in public areas, and to be sold without pictorial warnings of potential health hazards.

In Malaysia, the 2019 National Health and Morbidity Survey (NHMS) estimated that approximately five million Malaysians above the age of 15 are smokers.

Approximately 20,000 are killed annually (tobacco kills half of all its users) and the cost of just three smoking-related diseases is estimated at RM3 billion annually – a cost that is likely to be an underestimate.

It is therefore imperative that appropriate tobacco control policies are in place, and not subject to intense lobbying by those with vested interests.

As a party to the Framework Convention on Tobacco Control (FCTC) launched by the World Health Organization (WHO), the Malaysian government has a responsibility to ensure that policy- making adheres to the correct principles of tobacco control.

Intervention package

In 2008, WHO introduced the MPOWER concept, a package intended to assist with national-level implementation of interventions to reduce and prevent tobacco use.

It stands for:

M – Monitor tobacco use and prevention policies

P – Protect people from tobacco smoke

O – Offer help to quit tobacco use

W – Warn about the dangers of tobacco

E – Enforce bans on tobacco advertising, promotion and sponsorship

R – Raise taxes on tobacco

The above interventions have proven to decrease overall use of tobacco across the globe.

They do not work all the time for everyone, as each individual may respond differently.

Some will quit because the price is too high, others will quit because they are about to become parents.

Some are reminded of the dangers of cancer from pictures on a box, and others will be tempted to quit if the right quit-smoking tool is available.

Interestingly, an article in the journal Nature Medicine, published in January (2021), stated that “the greatest progress in reducing smoking prevalence would have been observed if a combination of higher prices and strictest P, W and E laws had been implemented by all countries, leading to lower smoking rates among men and women from all age groups”.

All these factors need to be borne in mind when pro-tobacco lobbyists come knocking on the door with the “harm reduction” sales pitch for HTPs.

Lessons need to be learnt from the experience of menthol cigarettes, where users ended up inhaling smoke more deeply and with health injuries that are just as damaging as “normal” cigarettes.

As Malaysia targets to reduce smoking prevalence to 15% by 2025 and to a tobacco endgame (prevalence less than 5%) by 2045, the government must continue to empower MPOWER and be wary of lobbyists furthering their own agenda.

Dr Helmy Haja Mydin is a respiratory physician and chief executive officer of the Social & Economic Research Initiative, a thinktank dedicated to evidence-based policies. For further information, email The information provided is for educational and communication purposes only. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

Source: The Star