Back in 2014, what started as a routine check-up for a patient turned into something Dr Rohan Sequeira, a medical doctor from India, still cherishes today. As an expert in Cardiology, Dr Sequeira had for years prescribed complete cessation of smoking to his patients as a way of slowing down the aggressiveness of cardiac-linked diseases.
However, something always troubled him. Despite recommending quitting, many of his patients failed to do so and over time, they would lose their lives to tobacco-linked ailments. Data shows that many smokers want to quit smoking but they fail despite repeated attempts
“In 2014, I was examining a patient and was telling him that you should stop smoking cigarettes because you have a heart problem,” said Dr Sequeira. “He looked at me and asked, Doctor do you smoke? and I said yes. He said you should not be telling me to quit then. The next day he came to my clinic with a device and that is when I came to know that there is something called a vape.”
From that day onwards, Dr Sequeira began what he described as a fulfilling journey that has greatly reduced the risks related to smoking combustible cigarettes.
Keep up with the latest headlines on WhatsApp | LinkedIn
“Being the medical professional that I am, I was a bit confused and I wanted to know more about this device. I went back and I spent two weeks reading everything about electronic cigarettes, finding out the pros and cons.”
During that period, he discovered that a lot of evidence was being ignored. Many people were simply talking against nicotine, against tobacco and against harm reduction, and nobody was giving smokers a viable alternative.
“That was one of the main reasons that convinced me that there could be a better way than just trying to enforce complete cessation.”
Resistance from Fellow Colleagues
A Rutgers-led study found that about 80 percent of physicians surveyed believed nicotine directly causes cancer. In India, medical doctors are among the main groups that do not support smoke-free products as alternatives to combustible smoking.
“The biggest problem I have had with my colleagues is outright refusal to believe that this is better,” added Dr Sequeira. “The common perception is that nicotine is cancerous and causes all the problems and that has been fed to them for so long that black has now become white. My biggest argument was with one of the best oral neck cancer surgeons in India. He simply refused to believe it.”
In India, research on nicotine products has been restricted since 2019. Technically it is not banned but prior approval is required and that approval is unlikely to be granted. Before the restrictions, an 18 week pilot study was conducted in Gujarat in western India to see whether Oral Nicotine Pouches could help people transition away from the smokeless oral tobacco that is widely used in the region. When the study was completed, the findings could not be published and the restrictions came into place shortly afterward. It remains the only documented study of its kind in India.
Have NRTs Failed?
Nicotine Replacement Therapies have been used since the 1980s to help smokers quit and have demonstrated moderate success in improving quit rates compared to placebo or no treatment. Studies show that NRT can double or more than double the chances of quitting, with success rates ranging between 6% and 30% depending on the population and how the therapy is used.
Despite this, people often struggle to quit even when using NRT due to biological, psychological and social factors. According to the Centre for Disease Control, nicotine is highly addictive, which makes quitting difficult.
“When my patients come to me and say look Doctor I am vaping, I take out mine and say cheers. The problem is that with NRTs people that quit often relapse over time. The long -term success ratio has always been around 5% to 7%. That means for every 100 people, only seven succeed in quitting permanently. Ninety three percent remain in this repetitive cycle and they cannot escape it. They get pulled into this spiral and they do not see any exit for themselves.
“Some of these are people with cardiac disease and diabetes and both are affected by chronic tobacco use. When you have a ban on certain products, there must be an alternative fall back program for people who want to quit. Almost everyone who smokes tobacco wants to quit.”
What Does the Evidence Say?
The evidence is already available. Sweden, Public Health UK and New Zealand provide clear examples of how alternative nicotine products can reduce harm. Local governments can adopt similar strategies or conduct pilot studies to understand how these approaches can be implemented at grassroots level.
India carries 40 percent of the world’s oral cancer burden. Of all cancers diagnosed in the country, 40 percent are oral cancers. Recent data shows that 95 percent of oral cancers in India are directly caused by smokeless oral tobacco.
A latest report on Lives Saved Report presents the most compelling evidence that comes from national case studies. In Sweden, cigarette smoking there has plummeted to only 5 percent of adults, the lowest in the EU, largely because many smokers switched to snus (a moist oral tobacco) over past decades, avoiding smoking entirely. Likewise, Japan saw an unprecedented 50 percent drop in cigarette sales within just 8 years (2012–2020) after heated tobacco products were introduced and widely adopted.
Sign up for free AllAfrica Newsletters
Get the latest in African news delivered straight to your inbox
Success!
Almost finished…
We need to confirm your email address.
To complete the process, please follow the instructions in the email we just sent you.
Error!
There was a problem processing your submission. Please try again later.
The Malaysian Experience: How Dr Sharifa Embraced Harm Reduction
As a medical doctor in Malaysia, Professor Dr Sharifa Ezat Wan Puteh has faced criticism for supporting Tobacco Harm Reduction, but her journey began from the opposite side. She initially believed vaping was harmful and accepted the dominant narrative around nicotine.
She was given a grant about 10 years ago to study vaping among adolescents. Her early work focused on identifying harms and recommending bans. After gaining more evidence, she began to realise that many people in other countries were using vapes as a harm reduction tool. Through further research and public speaking engagements, she concluded that vaping and other alternatives could play a useful role for adult smokers who are unable to quit through traditional methods.
Her shift in position attracted heavy criticism, including accusations of being sponsored or advocating for tobacco. She has denied these claims and continues to argue that non-smokers and adolescents should not use nicotine, but adult smokers who cannot quit should be offered safer alternatives. She notes that products such as e cigarettes, heat not burn and snus could all play a role, although affordability remains a challenge for many consumers.
