Boris Mendelevich: ‘Treatment for tobacco smoking can be included in Compulsory Medical Insurance system’

A column of the doctor, State Duma deputy one why the fight against smoking shouldn’t turn into the fight against smokers

Boris Mendelevich: ‘Treatment for tobacco smoking can be included in Compulsory Medical Insurance system’
Photo: Maksim Platonov

World No Tobacco Day declared by the UN was celebrated around the globe on 31 May. In a column for Realnoe Vremya’s readers, the State Duma’s deputy, psychiatrist Boris Mendelevich says why the line shouldn’t be crossed when fighting smoking.

A bit of statistics

One in five Russians smoke. This is the data of the Russian Statistics Service in 2019. According to the numbers, almost a fourth of Russians — 22,5% — smoke every day. 5,4% of smokers said they couldn’t live without cigarettes at all.

According to the World Health Organization, about a billion of 7,5 billion of the population of our planet smokes (or a third of the adult population). Moreover, a fall in smokers has been noted in the last years. There has been a big decrease thanks to a sudden fall in supporters of smoking among women — from 346 to 244 million. The number of smoking men doesn’t grow at the moment and it is even expected to reduce by two million people this year.


What’s the reason for the reduction?

Many countries’ governments take measures to reduce the number of smokers. Some state (like, for instance, in Italy) completely controls tobacco supplies to stores, grants licences to sell tobacco. There is an official list price for tobacco products, and stores don’t have the right to sell them neither higher nor lower than official prices. Retail sales of cigarettes are banned somewhere (like in Iceland). To purchase them, it is necessary to get a doctor’s prescription.

These measures together with social stimuli, particularly with developed sports infrastructure, bonuses for those who quitted smoking, allowed reducing the number of smokers.

What about Russia?

Large-scale measures to prevent tobacco consumption have been taken in our country in the last years. For instance, now cigarettes are permitted to be sold only in stores and without placing them in public, it is prohibited to smoke in public spaces (including cafes and restaurants, markets and shops, transport, workplaces in buildings, lifts and entrances, hotels and so no), tobacco advertising is banned. What is more, cigarette excises increased significantly, because of which they became expensive and less available. On the one hand, a rise in prices is an effective measure, but it is important that people not start smoking roll-ups with doubtful composition after that.

In quite an uneasy situation (when there are a lot of bans), simply prevention measures are needed. Particularly, a lot of sports venues are built, courtyards are repaired across the country. Also, I think some stimulating system would be effective. For instance, the return of VAT on gym membership.


Smoking and medicine

To smoke or not is a decision everybody makes oneself. However, one should understand that smoking is recognised as disease around the world, including in Russia, and it requires corresponding treatment (F17.2 Nicotine Addiction in the International Classification of Diseases. Clinical recommendations were created in our country and are in force. The Drug Dependency Clinic in Tatarstan has specialised rooms that help to stop smoking.

However, I personally think that one could go further and include smoking treatment in the Compulsory Medical Insurance system. Polyclinics are the primary link that is aimed to prevent diseases. And if a specific doctor and health care establishment has a stimulus to treat and make a patient healthier, and prevent tobacco smoking, the effectiveness can grow many times.

At the same time, it is very important to allocate public money and control the quality of medical services provided on this money. In polyclinics, there might be such criteria as the number of people who have diseases caused by smoking (such as lung cancer, tuberculosis, chronic obstructive pulmonary disease, etc.) or the number of smokers a doctor is in his area.

Smoking vs COVID-19

The new coronavirus pandemic is the topic of the last months. Considering that the virus affects the pulmonary system, there have appeared different opinions about the benefit/harm of smoking in case of contracting COVID-19. First, French scientists published research according to which smokers were less affected by the coronavirus than those who didn’t consume nicotine. 350 hospitalised patients and 130 outpatients participated in the research, everybody was found the coronavirus. Some people immediately supported this wave. However, it turned out that the number of smokers in this quantity was lower than in the population who were the same age and sex in general.


Some scientists anyway confirm the French scientists’ conclusions. But there haven’t been serious studies, and we should understand that it is only hypotheses, it is early to talk about something.

Moreover, both the WHO and health care ministries in some countries have rejected this fact, and Russia’s consume protection watchdog Rospotrebnadzor claimed that smoking worsened the performance of lungs: it becomes hard for a smoker’s organism to fight the coronavirus. Moreover, tobacco consumption augments the risk of contracting the infection through the mouth.

Execute impossible, to pardon

In the fight against the coronavirus, it is very important to remember that all these measures are taken to care about people’s health, and one shouldn’t cross the line.

I remember some initiatives, including those issued by public agencies, that, for instance, offered to cut smokers’ salaries. I personally don’t support such measures and think they aren’t designed to fight smoking but fight smokers. I think this shouldn’t be allowed.

P. S.: I don’t smoke, but in any case I will be against ineffective initiatives. Take care of yourself and stay healthy.

By Boris Mendelevich