Doctors: Caution needed in tobacco generation endgame

Doctors: Caution needed in tobacco generation endgame
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“Generation endgame, caution is needed”

The Control of Tobacco Product and Smoking Bill 2022, presently being tabled in Parliament, calls for the prohibition of smoking of tobacco products or substitute tobacco products and the prohibition of the use of smoking devices by any person that was born in 2007 and after.

The aim behind the Bill dubbed “Generation Endgame” (GEG) is to achieve the long-term objective of promoting tobacco-free future generations of Malaysians. This is undoubtedly a desirable outcome. However, it must be remembered that the two frontline countries in GEG, namely New Zealand and Australia, are first world developed nations. They have spent decades implementing sustainable policies, regulations and Tobacco Harm Reduction (THR) programmes in preparation for this move. In Malaysia, we have yet to embark on any meaningful THR programmes. This is in contrast to our previous experience with opioid addiction, where our HR (harm reduction) programme, commenced in 2006, had been a gamechanger resulting in long-term recovery of addicts, reducing drug-related arrests and HIV death rates in IV drug-users.

The Bill seems to have totally disregarded the overwhelming scientific data that THR can work with the proper regulatory framework in place. This is comprehensively documented in the Report of the Royal College of Physicians, UK 2016 (Nicotine without smoke: Tobacco harm reduction).

Provision 9(1) of this Bill has the effect of outlawing the dissemination of the information contained in this report and also makes its discussion by anyone a criminal offence.

It would be worthwhile for the legislators on both sides of the House to revisit this authoritative document and consider implementing policies that have been proven to work before embarking on the GEG. Pushing the GEG without this preparatory work will be a dangerous social experiment.

The dangers and consequences of tobacco products, especially combustible cigarettes are well documented. It is responsible for over eight million deaths per year worldwide.

Smoking, vaping and the use of tobacco products has major health consequences and are diseases of addiction. Like all addictions, they are amenable to proper medical intervention and treatment by specially trained professionals and not by criminalisation of the addict.

The Bill has a fundamental flaw. It has a provision that could potentially criminalise the young child who is caught in possession of a cigarette or a vaping device. This criminalisation approach is unlikely to work in the long run.

There are also no provisions in the Bill to address the current generation of smokers and vapers with sustainable THR programmes.

Our experience with community-based medical treatment for opioid addiction have shown that a specially trained nation-wide network of GPs (general practitioners) and family physicians are the people best equipped to handle this task. They are also the best first point of care for children caught experimenting with smoking and vaping. However, there are no provisions in the Bill to facilitate and to empower the medical professional for this task.

Our message to the present and next generation of Malaysians should be, “Don’t start, if you have started, do stop and if you cannot stop, seek help.”

We would appeal to our legislators to consider

  1. whether we are taking a shortcut to GEG without the benefit of prior sustainable policy-driven programmes on THR
  2. revisiting Provision 9(1), and
  3. making medical intervention as the focus of smoking and vaping cessation policy and not criminalisation.

 

Dr Steven Chow, President
Federation of Private Medical Practitioners’ Associations Malaysia (FPMPAM)

Founded in 1989, the FPMPAM has more than 5,000 members in seven state-level associations in the country. While it is primarily committed to improving the quality of private healthcare through continuing medical education, continuing professional development of its members and ethics advocacy, it has in recent years been focusing on frontier medicine, addiction medicine and a mentoring programme for trainee doctors.