The smoke lingers on

Of the many alarming statistics that a report on smoking and death in India recently published in the New England Journal of Medicine has thrown up, perhaps the most alarming is the one that says that only 2 per cent ever manage to kick the habit successfully. That's about the lowest in the world, less even than China's 10 per cent and Bangladesh's 8 per cent.

What is it that makes Indians such tenacious addicts of nicotine?

Samir Parikh, consultant psychiatrist with Max Healthcare, feels that's because most Indians feel that they can quit smoking on their own.

"How many people undergo comprehensive de-addiction programmes, which involve medicines, psychiatric help for counselling or cognitive behaviour therapy, group sessions and so on? In the West, that's standard practice. People need to look at smoking like they would any other medical problem."

Matters are slowly improving, says Parikh, with patients seeking his help to cease smoking slowly trickling in, but even so, he gets more people for alcohol dependence.

As much as quitting is a personal, private psychological problem, effective smoking-cessation programmes are a public health challenge too.

And it is here that India's entire health care mechanism is deficient, feels Monica Arora, director of HRIDAY (Health Related Information Dissemination Among Youth).

"Studies in the United Kingdom have found that if general practitioners (GPs) asked patients who came to them for any illness whether they smoked and told them to stop, it would cut prevalence by 5 per cent."

The other problem, of course, is the fact that you don't get nicotine patches and other aids easily in India. "The only drug available is Bupropion, and a three-month course of that turns out to be quite expensive," says Arora, who's been researching tobacco addiction and cessation patterns among youth for more than a decade.

What works best for India, she feels, is a community-based programme that comprises mainly behavioural therapy, again something that doesn't really happen in India.

"No wonder," says Arora, "Wills power wins out over will power every time."