Prof. B. M. Hegde,
Vice Chancellor,
MAHE University,
Manipal- 576 119.

A good friend of mine, an American citizen of Indian origin, Dr. Anirudh Srivastava, used to smoke like a chimney. Young as he was and brilliant in his field of specialization, I could see a bright future for him in the University of Georgia. With my love for life I influenced him to quit his smoking habit. Every smoker has a reason why he smokes! His was a very good reason, he also thought it was supported by science, of keeping his brain active while he worked on his teaching projects well into the early hours of the morning. The common myth that tobacco smoke keeps the brain alert had been supported by the pseudo-science of the tobacco lobby that manufactured small case control studies to support their view and did give it wide publicity, their best tool in spreading this kind of rumours.

The study that gave credence to the belief that tobacco smoke stimulates the brain came from the reductionist idea that nicotine stimulates the neuro-transmitters in the brain cells. We always make this fatal mistake in reducitonist science, where everything is split into its component parts and we study the last bit (cell) of the organism and then project that on to the organism. In the dynamic human system the bits may not make the whole. What happens between two cells need not happen between two million cells. This applies to most of our conclusions in medicine. It was therefore thought, supported by the tobacco lobby, that cigarette smoke keeps the brain cells alive and might postpone the onset of senility, even the onset of that dreaded disease of old age in the Caucasians, Alzheimer’s!

There is now some hope for truth to come out. A cohort study (better of the two varieties of epidemiologic studies in medicine) of doctors who smoked, that started in 1951, has now been completed. The leader of the study group has been the father of this kind of studies in Medicine, from Oxford, Sir Richard Doll. Sir Richard started the study in 1951 and has been lucky to be at the helm of affairs even when the study ended in 1999. The study clearly showed that smoking does not confer any benefit as far as senility goes or for that even in Alzheimer’s disease. On the contrary, smokers have a larger incidence of vascular brain damage because of the bad effects of tobacco smoke on the blood vessels, resulting in lacunar infarcts in the brain (areas of brain tissue death too small to cause symptoms individually), thereby increasing the incidence of vascular origin Alzheimer’s. Long time smokers have greater degree of senility compared to non-smokers.

This should set at rest, for all times, the myth that smoking cigarettes gives immunity against premature senility or even gives better intellectual prowess to the brain. (BMJ 2000, 22nd April issue). The study also threw light on another aspect of the problem. When the study started smoking was considered as a sign of the higher class of people with prosperity. When it ended smoking is considered to be the prerogative of the poor in society and also those that are less endowed! This has been the changing scenario in society. That, to a certain extent, has brought down smoking among the upper echelon of society from where many of the doctors in that society come from. Of course the greater influence has been the fact that smoking is now connected very strongly with many cancers and also vessel diseases led by heart attacks. The dangerous part of the latter is that sudden death as a manifestation of coronary heart disease is predominantly a smoker’s prerogative.

The Dutch have come down heavily on the alcohol lobby in their country. From the land of the Heineken beer the news is not very good for the alcohol lobby. The government has declared that selling alcohol to children below the age of 18 years is illegal. Even advertising alcohol directly or indirectly in any media is an offence punishable with a fine equivalent of Indian Rupees two and half lacs. Alcohol advertising hoardings should not be near schools or be seen from any school or approach to a school. All childrens’ parties where children below 18 gather, alcohol should not be served. In the Netherlands this is very good news. I hope other countries have the guts to do just that. There is even a ban on MTV shows in that country advertising alcohol indirectly!

The greatest myth in this field has been the advertisement, mainly through the medical lobby, that drinking a small quantity is good for health, that too it lessens the risk of a heart attack! I have been consistently writing that this is a not just a myth but a large fraud on the public, abetted and aided by a section of the powerful medical lobby. I was being hated for that; even my own colleagues used to laugh at me behind my back. I was an object of ridicule in all parties in Mangalore. One of my friends and a colleague was once heard remarking that “ if a patient sees BMHegde, he will be asked to stop drinking; whereas I would want him to start drinking to help his heart. BMHegde is doing injustice to his patients!”

Another long-term cohort study published in the prestigious medical journal Heart (2000;83:394-399) clearly sets at rest any doubt people might have in this field. This study showed, after a very long observation lasting for decades, that those who drink a small amount and those who abstain have no difference in the rate of heart attacks and other heart diseases. However, the study clearly showed that those with heart disease, especially those who have had a heart attack in the past, are at a great risk if they drink alcohol. The risk of another heart attack as also other complications is significantly higher in those who drink moderately or even heavily.

In a sensible book Science Without Sense (Published by the CATO Institute in Washington DC 1999) the author, an American, Steven Milloy says “ epidemiology is where the gold rush is and if a researcher wants to make it big faster he has to get in here. There are two basic types of studies-cohort and case control. Avoid cohort studies. They are time consuming and the results may take about twenty years. By then the funding may not be there and your career would take a long time to improve. Case control studies are faster, the money is there still and the CV gets bloated fast with new publications. You simply scrounge up a group you can look at in retrospect. It is like Monday morning quarterbacking, only better. At the end of this game, you can adjust the score almost anyway you want.”

Most of the studies that the newspapers publish in thick letters saying coffee does this or smoking protects or even alcohol protects against heart attacks come from such case controls. While it true that we have no hard data to say that a small quantity of alcohol might damage the system so badly, we have no data at all to say that small quantity of alcohol helps the heart or for that matter any organ of the human system. Even a teaspoon of alcohol raises the systolic blood pressure temporarily. That may or may not have long term effect. Similarly every teaspoon of alcohol damages and kills a few hundred of the cerebellar cells, the ones needed for balancing your body. (The unsteady gait of the really drunk is the result of the cumulative damage to the cerebellum). Even though we do not know for certain if these small dose effect get reversed as time passes they are seen to occur. With this background to say that small quantity helps looks a mockery of the truth.