Nearly 80% of the surveyed doctors in India incorrectly believe nicotine in tobacco products causes cancer

New Delhi: A recent study of knowledge, attitudes and practices in the domain of tobacco and tobacco cessation among healthcare practitioners in India identifies a “policy-practice” gap between prescribed WHO policy guidelines and the actual practice by the healthcare practitioners. Dr Sudhanshu Patwardhan of the Centre for Health Research and Education (CHRE, UK) led the study and states: “Doctors, dentists and nurses are trusted by patients to not only provide them with accurate treatment but advice on preventing diseases as well. Tobacco cessation should be on the top of their minds as tobacco use is one of the most widespread acquired habits negatively influencing general well being of patients. However, our healthcare practitioners need adequate training to address this concern as it is resulting in limited cessation advice to patients. India’s tobacco epidemic can only be reversed if those who are in a position to influence tobacco users’ decisions are well equipped with the knowledge and tools for helping their patients to quit tobacco!”

In the latest issue of the prestigious Indian Journal of Clinical Practice, a team of Indian medical and academic experts have published a study titled “A Pilot Study to Assess the Knowledge, Attitude and Practice Among Healthcare Practitioners in India Regarding Tobacco Use and Cessation” covering this important facet.

The research was a joint international effort between medical researchers from the UK and India.

The Indian tobacco market contains a wide variety of tobacco products, including cigarettes, bidis and oral preparations such as gutkha, khaini, zarda, among others.  All forms of available tobacco products in India are harmful for health and there is an urgent need to help the nearly 300 million tobacco users in India to quit successfully and immediately. “Doctors have a key role to play in tobacco cessation by providing adequate behavioural support and prescribing nicotine replacement therapy, if needed” says Dr Gaurav Kale, of the Tobacco Research and Cessation Network and co-author of the study.

A key finding of the study is that nearly 80% of the 619 healthcare practitioners surveyed from around the country incorrectly believe that it is the nicotine in tobacco products that causes cancer. Pharmaceutical nicotine, extracted from tobacco plants, is in fact recommended to provide craving relief and manage withdrawal symptoms for patients attempting to quit risky tobacco products. Dr Patwardhan states: “According to the WHO, nicotine in the form of medically licensed replacement therapy (e.g. nicotine gums or patches) is classified as an essential medicine to helping treat tobacco dependence. Doctors’ prevailing misperceptions about nicotine’s safety profile can be a huge hurdle in prescribing adequate medicinal nicotine for long enough.”

One of the authors, senior tobacco control researcher Professor Rajesh Sharan (NEHU, Shillong) condemns the state of tobacco cessation support available in the country: “Tobacco use prevalence in the North Eastern states of India is unacceptably high as compared to the national average. More than 50% of adults here consume tobacco in oral or smoked forms. Of special concern to me is the high prevalence of smokeless tobacco use among women, children and marginalized sections of the society. However, access to required medical intervention and behavioural counselling for tobacco control is limited to a very few urban centres.”

The study highlights the limited inclusion in the educational curriculum of the medical and allied sciences in India of latest evidence based tobacco cessation practices or a deeper understanding of tobacco dependence and harms. As a result, the different available behavioural approaches to helping patients quit oral or smoked tobacco and the role of nicotine replacement therapy in achieving tobacco harm reduction are not adequately understood or practised.

The authors are encouraged from the survey finding that healthcare practitioners are keen to learn more on tobacco cessation methods to help patients quit tobacco. “We are confident on using mobile and e-learning based innovative technologies and virtual conferencing to rapidly upskill and empower India’s millions of healthcare practitioners on tobacco cessation in the coming years”, Dr Patwardhan believes, “and through them support hundreds of millions of Indians lead longer, healthier, tobacco-free lives.”