I want to introduce you to a new drug. You may want to use it, indeed many people across the world do. It is from a natural source that is cheap to make and is easy to use. It is a helpful drug. In that it can help with stress relief, it reduces appetite a little and can lead to a transient feeling of well-being. Gosh, you may ask. What is this and can I have some?
Well before you can take this new medication you need to be aware of a few downsides. It is addictive. In fact, many people who take it find that they cannot stop and have to continue on it. Stopping abruptly can lead to alterations in mood and significant physical symptoms. Taking this medication long term may lead to harm. It affects your skin, sense of smell and taste and can leave an unpleasant odour. It is also possible that in taking this medication that you will develop heart disease, peripheral vascular disease, increase your risk of stroke and lung cancer. The people you live with may also be affected if you take this medication near them with similar health problems. It is thought that up to 50 per cent or more of those that take this medication long term will die as a result of the medication, and die prematurely.
So, what do you think? On balance would you start this medication? Would you use it long term if you knew the personal consequences?
I suspect that you would not.
Perhaps another significant question to ask is: would such a medication ever be approved for use? The answer is clearly no. If any pharmaceutical company produce a drug that was addicted and killed over half of the patients who took it then it would never be approved.
So what am I talking about? Tobacco. This product still has a grip on the Western World and the influence of the companies is growing in developing countries. In many places from a safety perspective, tobacco is classed as a foodstuff rather than a pharmacologically active substance. The harm caused by cigarette smoking and all other forms of tobacco use is well recognised and is medical fact. This harm occurs slowly and accrues as we age and as we smoke. It leads to mortality, but from my perspective dying often is the least of my patients worries. They have to live with a poor health-related quality of life until they die. They have heart attacks and lung damage which leads to breathlessness. They have strokes which lead to disability and they suffer the indignity of an increasingly medicalised home life. They also carry with them the guilt of knowing the underlying cause of their problems, however, much healthcare professionals support and reassure. And then they die.
So, with this in mind would you choose to try this medication? Would you give it to your children or allow them to try it at 16?