What You May not Know What You May not Know About Tobacco?About Tobacco?

Dr. Mohammed AlbarDr. Mohammed AlbarDirector of medical ethics centerDirector of medical ethics center

IMC, JeddahIMC, Jeddah

Deaths Due to Tobacco Deaths Due to Tobacco ConsumptionConsumption

19001 to2000: 100 million deaths.19001 to2000: 100 million deaths.2001 to 2100: 1000 million.2001 to 2100: 1000 million.Half of the smokers living today (2005) Half of the smokers living today (2005) i.ei.e 1300 million will die due to diseases 1300 million will die due to diseases caused by tobacco consumption caused by tobacco consumption ieie 650 650 million. million. 90% of all deaths in developing 90% of all deaths in developing countries.countries.

Annual deaths at 2000:5 million.Annual deaths at 2000:5 million.Annual deaths at 2015 :10 million.Annual deaths at 2015 :10 million.Nuclear bombs at Hiroshima and Nagasaki Nuclear bombs at Hiroshima and Nagasaki killed 125,000 persons immediately and killed 125,000 persons immediately and 125,000 over the years because of 125,000 over the years because of cancers.cancers.

Merchants of deathMerchants of death

The American Tobacco Industry.The American Tobacco Industry.Larry White.Larry White.Forwarded by Everett Koop.Forwarded by Everett Koop.Surgeon General of USA.Surgeon General of USA.““worse than nuclear weapons and plagueworse than nuclear weapons and plague””..

Deaths in USA (unually)(1980Deaths in USA (unually)(1980--1990)1990)

TobaccoTobacco 400,000400,000AlcoholAlcohol 100,000100,000Car accidentCar accident 25,00025,000Murder and Murder and violantviolant crimes 35,000crimes 35,000All drugs of abuse All drugs of abuse 20,00020,000

Deaths in U.K ( annually)Deaths in U.K ( annually)

Tobacco Tobacco 110,000110,000AlcoholAlcohol 25,00025,000Abuse of drug e.g. 160Abuse of drug e.g. 160--180180

Heroin, amphetamineHeroin, amphetamineand glue etcand glue etc

Tobacco deaths in Asia ( annually)Tobacco deaths in Asia ( annually)

China: 1 millionChina: 1 millionIndia: 800,000 India: 800,000 --1 million1 million

Deaths in Saudi Arabia ( annually)Deaths in Saudi Arabia ( annually)

TobaccoTobacco 23,00023,000Traffic accident Traffic accident 8,0008,000Terrorist activities 20Terrorist activities 20--6060

Lung Cancer in Saudi ArabiaLung Cancer in Saudi Arabia

90% of lung cancer is due to smoking.90% of lung cancer is due to smoking.Taylor study (1961)(Aramco Eastern Province): Taylor study (1961)(Aramco Eastern Province): the 12the 12thth deadly cancer in males.deadly cancer in males.Al Al AqqadAqqad study (1979study (1979--1984) (king Faisal 1984) (king Faisal Hospital, Riyadh): 3Hospital, Riyadh): 3rdrd deadly cancer in males.deadly cancer in males.King Faisal study ( 1990): 2King Faisal study ( 1990): 2ndnd deadly cancer in deadly cancer in males.males.Al Tamimi T, Albar A( 1996) (Eastern Al Tamimi T, Albar A( 1996) (Eastern Province):1Province):1stst deadly cancer in males and the 2deadly cancer in males and the 2ndnd

deadly cancer in females.deadly cancer in females.

Hospital Admission in Saudi ArabiaHospital Admission in Saudi Arabia

Because of smoking: 250,000 cases Because of smoking: 250,000 cases annually. annually. Costs to Ministry of Health 5 billion S.R Costs to Ministry of Health 5 billion S.R annually.annually.The street value of cigarettes is >2 billion The street value of cigarettes is >2 billion dollars.dollars.

Smoking & GNPSmoking & GNP

Smoking reduces GNP through:Smoking reduces GNP through:Premature deathsPremature deathsDisability and ailmentsDisability and ailmentsAbsenteeism from workAbsenteeism from workDecrease productionDecrease productionIncrease health budgetIncrease health budgetIncrease fires and accidentsIncrease fires and accidents

Tobacco CultivationTobacco Cultivation

77thth crop of the world in 120 countries.crop of the world in 120 countries.10 million tons of tobacco produced annually. 10 million tons of tobacco produced annually. Pesticides are used without protection (masks, Pesticides are used without protection (masks, boots etc) resulting in: increase deaths, cancers, boots etc) resulting in: increase deaths, cancers, sterility, abortion, paralysis and increase sterility, abortion, paralysis and increase congenital malformations.congenital malformations.Pesticides sold to developing countries are Pesticides sold to developing countries are banned in the producing countries itself.banned in the producing countries itself.

Tobacco CultivationTobacco Cultivation

Drying of tobacco leaves by burning Drying of tobacco leaves by burning forests:forests:7 millions hectares are burnt annually in 7 millions hectares are burnt annually in developing countries to dry tobacco developing countries to dry tobacco leaves.leaves.Dangers to ecoDangers to eco--systems and pollution.systems and pollution.Wealthy countries use gas and petroleum Wealthy countries use gas and petroleum for drying tobacco leaves.for drying tobacco leaves.

Tobacco industryTobacco industry

7 giant tobacco companies control world 7 giant tobacco companies control world wide cultivation, production and wide cultivation, production and marketing.marketing.Annual sales 300 billion dollars.Annual sales 300 billion dollars.Philip Morris distributes 175 brands in 160 Philip Morris distributes 175 brands in 160 countries.countries.Using pressure, money deceit to continue Using pressure, money deceit to continue poisoning the earth population and mass poisoning the earth population and mass killing.killing.

USA cigarettes Exports to USA cigarettes Exports to Developing countiesDeveloping counties

8% of total production in 19848% of total production in 198434% in 199434% in 1994Trade surplus from tobacco exports in Trade surplus from tobacco exports in 1990 was 4.2 billion dollars.1990 was 4.2 billion dollars.

Tobacco Lobby in USATobacco Lobby in USA

420 congressmen420 congressmen87 Senators 87 Senators

Accepted tobacco companies contributions Accepted tobacco companies contributions and support in their election campaigns.and support in their election campaigns.FDA never regulated cigarettes as drug FDA never regulated cigarettes as drug delivery system for nicotine, and never delivery system for nicotine, and never subjected tobacco products to safety and subjected tobacco products to safety and health regulation . health regulation .

Tobacco Litigation in USATobacco Litigation in USA

Huge increase of Litigation cases against Huge increase of Litigation cases against tobacco companies in 1990s.tobacco companies in 1990s.800 cases up to 1998: 600 million dollars 800 cases up to 1998: 600 million dollars paid annually by tobacco companies.paid annually by tobacco companies.In 1999: the federal courts indicted In 1999: the federal courts indicted

tobacco companies and ordered them to tobacco companies and ordered them to pay 386 billion dollars over 20 years to the pay 386 billion dollars over 20 years to the statesstates-- government.government.No litigation accepted from outside USA.No litigation accepted from outside USA.

Maryland court ordered 5 tobacco Maryland court ordered 5 tobacco companies in 16/7/2000 to pay 145 billion companies in 16/7/2000 to pay 145 billion dollars for the victims of tobacco in dollars for the victims of tobacco in Maryland.Maryland.Hostesses were paid in Florida 350 million Hostesses were paid in Florida 350 million dollars in compensation by tobacco dollars in compensation by tobacco companies.companies.

Tobacco Imports in Saudi ArabiaTobacco Imports in Saudi Arabia

1,400,000,0001,400,000,00045,000,00045,000,00019941994

1,173,350,0001,173,350,00042,377,00042,377,00019841984

350,382,000350,382,00027,027,00027,027,00019771977

117,308,000117,308,0004,575,004,575,0019721972

Value in Saudi Value in Saudi RiyalsRiyals

Import in Import in kilogramkilogram

yearyear

Each kilogram= 1280 cigarettes.Each kilogram= 1280 cigarettes.The annual increase 1972 to 1984 = 90%The annual increase 1972 to 1984 = 90%The highest in the world!The highest in the world!

The value of tobacco (1991) In The value of tobacco (1991) In Saudi Arabia 1,4 billion Riyals Saudi Arabia 1,4 billion Riyals

Import from USA: 50%Import from USA: 50%Import from U.K: 25%Import from U.K: 25%Import from Switzerland 13%Import from Switzerland 13%

Taxes on cigarettes increased Taxes on cigarettes increased graduallygradually

From 15% to 30% (1980s).From 15% to 30% (1980s).To 50% (early 1990s) to 100% (late 1990s).To 50% (early 1990s) to 100% (late 1990s).

Smuggling of TobaccoSmuggling of Tobacco

As the tax increased so did the smuggling.As the tax increased so did the smuggling.In 1991 the value of tobacco was reported In 1991 the value of tobacco was reported at 1400 million Riyals.at 1400 million Riyals.In 2005 the value came down to 600 In 2005 the value came down to 600 million Riyals.million Riyals.There is a huge increase of consumption There is a huge increase of consumption due to the increase of population from 8 due to the increase of population from 8 millions to 23 millions.millions to 23 millions.

Smuggling BattleSmuggling Battle

Stop smuggling by giving huge incentives Stop smuggling by giving huge incentives to customs officers.to customs officers.the tax should be doubles or tripled the tax should be doubles or tripled

(200%(200%--300%) for confiscated tobacco.300%) for confiscated tobacco.

Ban on Smoking at Public SpacesBan on Smoking at Public Spaces

Should be strictly enforced.Should be strictly enforced.Fines should be paid immediately.Fines should be paid immediately.To encourage fine collection, give To encourage fine collection, give incentives to fine collectors.incentives to fine collectors.

••Ban selling tobacco to under 18 Ban selling tobacco to under 18 and enforce the ban by heavy and enforce the ban by heavy

fines.fines.

King Faisal Hospital Expenses on Treating King Faisal Hospital Expenses on Treating tobacco diseasestobacco diseases Estimated at 10 billion Estimated at 10 billion dollars. (20 years).dollars. (20 years).The American courts refused the The American courts refused the Litigation.Litigation.

Litigation should be directed Litigation should be directed against tobacco importers in the against tobacco importers in the Kingdom.Kingdom.

If one importing company is If one importing company is indicted, the others will be indicted, the others will be victimized. The smoking epidemic victimized. The smoking epidemic will be curbed.will be curbed.

Nicotine is AddictiveNicotine is Addictive

The production and promotion of tobacco is The production and promotion of tobacco is more dangerous than all drugs of addiction more dangerous than all drugs of addiction combined. Nicotine is more addictive than combined. Nicotine is more addictive than cannabis ( Hashish, marijuana) , cannabis ( Hashish, marijuana) , phentylinephentyline, , amphetamines and amphetamines and QatQat. It is as addictive as . It is as addictive as heroin and cocaine.heroin and cocaine.WHO report on smoking 1986, Royal college of WHO report on smoking 1986, Royal college of physicians report on addiction, 2000. physicians report on addiction, 2000.

Tobacco companies entice school children Tobacco companies entice school children to smoke.to smoke.Children smoking cigarettes and Children smoking cigarettes and sheeshasheeshain Saudi Arabia.in Saudi Arabia.Playing with Sheesha starts with toddlers.Playing with Sheesha starts with toddlers.

Passive smoking and fetusPassive smoking and fetus

Increase spontaneous abortion.Increase spontaneous abortion.Premature labor.Premature labor.Small for date.Small for date.Still births and early neonatal deaths.Still births and early neonatal deaths.Reduction of growth.Reduction of growth.CarboxyCarboxy HB in newly born from HB in newly born from sheeshasheeshasmoking mother reaches 30%.smoking mother reaches 30%.

Passive smoking And childrenPassive smoking And children

If both parents smoke ,each child inhales If both parents smoke ,each child inhales smoke equivalent to 60smoke equivalent to 60--150 cigarettes per 150 cigarettes per year.year.Increase cot death.Increase cot death.Serious respiratory diseaseSerious respiratory diseaseIncrease asthmaIncrease asthmaDeafness of children ( glue ear)Deafness of children ( glue ear)Increase school absenteeism.Increase school absenteeism.

Children who smoke (U.K)Children who smoke (U.K)

By the age of 11 year 1/3 of children have By the age of 11 year 1/3 of children have experimented with smoking.experimented with smoking.by age of 16 years 2/3 have done so.by age of 16 years 2/3 have done so.

¼¼ of those aged 15 yearsof those aged 15 years are regular are regular smokers.smokers.In many countries in the west girls exceed In many countries in the west girls exceed boys in smoking.boys in smoking.

Children who smokeChildren who smoke

Marked increase of respiratory diseases, Marked increase of respiratory diseases, asthma and ENT diseases.asthma and ENT diseases.Decrease of immunity and increase HIV Decrease of immunity and increase HIV infection.infection.Decrease fertility for girls who smoke.Decrease fertility for girls who smoke.6 times increase of subarachnoid. 6 times increase of subarachnoid. hemorrhage compared to non smokers.hemorrhage compared to non smokers.Prone for drug addiction.Prone for drug addiction.

Sheesha, Sheesha, MoasselMoassel and and GorakGorak

Sheesha: is tobacco in hubbleSheesha: is tobacco in hubble--bubble bubble water pipe.water pipe.MoasselMoassel: is tobacco + molasses: is tobacco + molassesGorakGorak: is tobacco + rotten fruits: is tobacco + rotten fruits

Alcohols including ethyl alcohol are Alcohols including ethyl alcohol are produced in the smoke.produced in the smoke.

High content of CO in SheeshaHigh content of CO in Sheesha--MoesselMoessel & & GorakGorak

CarboxyCarboxy HB cause increase cholesterol HB cause increase cholesterol (LDL) , platelet aggregation, (LDL) , platelet aggregation, polycythemiapolycythemia, , marked increase of strokes , coronary marked increase of strokes , coronary thrombosis and peripheral circulation.thrombosis and peripheral circulation.

CarboxyCarboxy HbHb in Saudi Arabiain Saudi Arabia

7.86%7.86%10.47%10.47%sheeshasheesha

3.86%3.86%6.47%6.47%Cigarette Cigarette smokerssmokers

0.6%0.6%1.6%1.6%Non smokersNon smokers

femalesfemalesmalesmales

One One sheeshasheesha is worse than 10 is worse than 10 cigarettes /daycigarettes /day

Smokeless TobaccoSmokeless Tobacco

BatelquidBatelquid, , bantubantu: nasal and oral snuff: nasal and oral snuffSudan: Sudan: SaffaSaffa, , ShammaShammaSaudi Arabia Saudi Arabia ( ( GizanGizan) and Yemen: ) and Yemen: ShammaShamma, , MadghaMadghaWide spread in USA ( take a pouch instead Wide spread in USA ( take a pouch instead of a puff)of a puff)

Smokeless Tobacco & CancerSmokeless Tobacco & Cancer

The increase of incidence compared to The increase of incidence compared to smokers:smokers:

Oral cancer 70%Oral cancer 70%OropharynxOropharynx 84%84%Hypopharynx75%Hypopharynx75%Larynx 78%Larynx 78%Esophagus 50%Esophagus 50%

Best policy to combat tobacco useBest policy to combat tobacco use

Increase taxation and tobacco companies Increase taxation and tobacco companies litigation.litigation.Stop smugglingStop smugglingBan advertisementBan advertisementBan smoking in public places and implement itBan smoking in public places and implement itReligious FatwasReligious FatwasMass education at media, schools and hospitalsMass education at media, schools and hospitals

Smoking is HARAMSmoking is HARAM

More than 400 fatwaMore than 400 fatwathe 1the 1stst Fatwa by Sheikh Ibrahim Fatwa by Sheikh Ibrahim AllakaniAllakani

(Sheikh AL Azhar) in 1015 H/ 1605 AD.(Sheikh AL Azhar) in 1015 H/ 1605 AD.All the All the UlemaUlema of Saudi Arabia since 300 of Saudi Arabia since 300 yearsyearsAll contemporary All contemporary ulemaulema of Egypt of Egypt ((ALazharALazhar) )

King James I 1604King James I 1604

Tobacco smoking is loathsome to the eye, Tobacco smoking is loathsome to the eye, hateful to the nose , harmful to the brain, hateful to the nose , harmful to the brain, dangerous to the lung and in the black dangerous to the lung and in the black stinking fumes thereof , nearest stinking fumes thereof , nearest resembling the horrible Stygian smoke of resembling the horrible Stygian smoke of the pit that is bottomlessthe pit that is bottomless

Millions quit smokingMillions quit smoking

In USA: 34 millions ( 1964In USA: 34 millions ( 1964--1986)1986)In UK: 10 millions (1964In UK: 10 millions (1964--1986)1986)The figures doubled since thenThe figures doubled since then

Doctors taking the leadDoctors taking the lead

In UKIn UK1955: 55% smoke1955: 55% smoke1970: 20%1970: 20%1990: 10%1990: 10%2000: 2%2000: 2%

In Saudi ArabiaIn Saudi Arabia

Before 1990: 40% of male doctors smokeBefore 1990: 40% of male doctors smokeAfter 1990: 30% of doctors smokeAfter 1990: 30% of doctors smoke

Women smoking in Saudi ArabiaWomen smoking in Saudi Arabia

Women were not smoking except in few Women were not smoking except in few citiescitiesNow 30% ofNow 30% of secondary school student secondary school student smokesmoke40% of university students smoke40% of university students smoke40 % of school teachers smoke40 % of school teachers smoke

The health professionals should The health professionals should lead the fight against the most lead the fight against the most

dangerous yet preventable dangerous yet preventable health hazardhealth hazard

شكرًا شكرًا والسالم عليكم ورحمة اهللا والسالم عليكم ورحمة اهللا

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