ICMR BULLETIN VOL. 25-No.-5-MAY-1995.pdf

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ISSN 0377-4910

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May, 1995

Vbl.25, No.5
ECONOMICS OF TOBACCO
Epidemiological studies and experiments on ani­
mals and cell lines, have proved beyond doubt that
tobacco is a health hazard. Some well designed cohort
and case control studies of the 1950s, and the US
Surgeon General's report in 1964, forced various govern­
ments to consider corrective actions for control of
tobacco use. Anti-tobacco community education was
the first step initiated fbr this purpose. Other steps like
reduction or ban on advertisements of tobacco prod­
ucts, tobacco free places for protection of non-smokers,
increase in price of tobacco, etc, also followed. How­
ever, no major action has been taken to reduce the
availability of tobacco. Not only does the production
of tobacco continue unabated, but steps are also being
taken for increase in production and productivity of
tobacco. The most important reasons for these contra­
dictory actions, are the economics of tobacco, ie tobacco *s
contribution to revenue, and dependence of a large
number of persons on its production, processing and
sale.

The fear of loss of revenue is so deep rooted that
even a country like the USA is using taxpayers* money
to subsidize the tobacco industry1. The common ag­
ricultural policy of the European Community subsi­
dizes tobacco production to the tune of 1,300 million
ecu a year (equivalent to US$ 1,500 million). This
amounts to 2,500 ecu ($3,100) per minute, and is
more in one year than the total amount spent on tobacco

subsidies by the US in the last 50 years . : ? *
objectives of health departments for contro o 0
are in absolute contrast with the goals of agncu u
agencies, which aim at promotion of tobacco produc・
tion and promotion of tobacco marketing3. The revenue
generated by tobacco and dependence of 5 to 7 nil ion
persons on tobacco, is often considered as sufficient
reasons to defer a serious thought about tobacco s
eradication. The political will and stern steps needed
to counterbalance the economic and social impacts are
lacking. Hence the governments have not taken major
steps to eliminate or reduce tobacco cultivation, and

thus availability to the community.
While generation of revenue fbr the governments
and livelihood for people is one side of the economics
of tobacco, the other aspect is the expenditure by
patients and governments on treatment of diseases caused
by tobacco. The loss to national productivity occurs due
to reduced efficiency, disability or premature death of
patients of tobacco related diseases. Tobacco is the
single major cause of mortality all over the world. It
has been estinfated that in 1990s, 3 million deaths
would occur every year all over the world, due to
tobacco use. The annual global toll is likely to be 10
million by the year 20204. In India, tobacco is respon­
sible for about 800,000 deaths every year, mainly due
to cardiovascular diseases, chronic obsWuctive lung
diseases, and tobacco related cancers (Indian Council

Division of Publication & Information, ICMR, New Delhi - 1 io 029

of Medical Research, unpublished data). Based on data
from Indian studies, the estimates for the annual num­
ber of persons developing diseases attributable to their
tobacco habit in the mid 1980s, included 108,000
annual incident cases of cancers, 1.3 million prevalent
cases of coronary heart disease, and at least 7.0 million
prevalent cases of chronic obstructive lung diseases5.

Due to the large proportion of people affected by
tobacco related illnesses in the community, health per­
sonnel believe that the money spent by the patients and
government on treatment of tobacco related diseases is
more than the revenue generated by tobacco. The belief
gets strengthened due to the facts that tobacco induces
more deaths before retirement age among users than
among non-users; non-fatal tobacco illnesses create
disability; tobacco users have increased absenteeism;
and tobacco generates extra demand for medical care6,
and creates an ecological imbalance7.

not impose special taxes on motorcyclists, skydivers,
and compulsive overeatefs, fbr example, in order to
make them pay for the full costs of their health care?”'.
The author of this review believes that consideration
of social costs imposed by tobacco use are important,
since social costs may be a hindrance to a society's
progress. Any society would tend to reduce or remove
any human behaviour which may endanger the freedom
of others in the society or if it affects its progress,
socially or financially (say in its GNP). The felling of
trees was not considered important by many countries
till the ecological importance of trees was realized. Due
to this realization, many governments have controlled
the cutting of trees, if owned by an individual. While
individuals with a commercial point of view ignore the
consideration of social costs during such calculations,
they vociferously talk about social implication of a large
number of people loosing their jobs when the issue of
replacement of tobacco cultivation is considered.

Differences of Opinion in Estimation of Economic
Burden of Tobacco Use

Economic Implications of Tobacco Control

Computation of economics of tobacco is a difficult
arena, not only because of difficulty in converting
certain effects into monetary equivalents, but also be­
cause of differences on inclusion or exclusion of some
aspects in specific context of the country. For example,
absenteeism due to tobacco related diseases may be
important in some developed countries, but may assume
a lesser importance in other circumstances, where certain
amount of leave may be available to the patient. Dif­
ficulty arises in converting the misery associated with
diseases caused by tobacco, and the pleasure derived
by people using it. In any cost-benefit analysis on
tobacco, there is no other way, but to assume that the
two kind of feelings would balance each other. There
is a continuing difference of opinion between those who
have the health of the people in mind, and others who
generally have a commercial angle in mind. The health
proponents feel that effects like premature death, and
loss due to decreased efficiency should be included as
losses due to tobacco, whereas some people believe that
the people are free to decide about smoking as long
as they are paying for it, and for treatment of the
tobacco related diseases. Those opposing inclusion of
social costs believe that "if we can justify taxing one
activity on the grounds that those who engage in it are
risking their health, then we can justify taxing a large
number of risky activities on the same grounds. Why

The socio-economic effects of tobacco use may be
due to direct medical care costs, which relate to pay­
ments (by the individual patients, their relatives/ friends,
or government) for diagnosis and treatment of the
illnesses or for correction of the disability due to
tobacco related diseases. Indirect morbidity costs due
to tobacco use are a result of decreased efficiency —
even if apparent illness has not set in — and the loss
of productivity due to absenteeism and disability. Some
scientists believe that the period during which tobacco
was used should also be included in such calculations
as the person is not contributing to productivity during
this time. The indirect costs of mortality are due to
premature death. Other social costs due to tobacco
include ecological effects due to use of wood fbr curing
tobacco and use of paper fbr cigarette wrapping, pack­
aging and advertising; reduced land for food produc­
tion; loss due to fires caused by tobacco (cigarettes
cause at least one quarter of all fires7); expenses on
fighting the fires caused with tobacco; expenses on
maintaining the cleanliness of public areas littered by
cigarette butts, discarded packages, matchboxes, matches,
etc; and higher maintenance cost of ventilating systems
due to smoking6,7. The costs due to fires may become
very important in some countries. For instance, in
Hong Kong, 33 per cent of all reported fire accidents
between 1976 and 1983 were considered by the fire

56

service department to have been cause by smoking.
There is also evidence that smokers have more auto­
mobile accidents and accidents at work than non-smok­
ers9.

Estimates have befen made on the effect of inter­
vention packages for gradual reduction of tobacco use,
on revenue to the government. Atkinson and Townsend10
estimated the effect on revenue of a package to reduce
smoking by 40 per cent by increasing tax, reducing
advertising, and implementing a serious sustained health
publicity programme. Even though the reduction in
national health services usage was expected to be marginal,
the overall savings due to health services use, sickness
benefits and widows* benefit, amounted to £31 million
annually.* After subtraction of costs due to retirement
pensions and expenditure on health education, the net
annual savings in 1976-80 was expected to be £17
million. It was estimated that increased tax on cigarettes
would bring extra revenue of £85 million. Another
analysis of the economic impact of a 20 per cent
reduction in smoking from 1973 to 1981 in the United
Kingdom, showed an estimated £42 million increment
to the GNP, at 1973 values11.
It is also argued that if tobacco does not exist,
people would spend the same money in some thing else,
which would of&et a substantial portion of the loss due
to lost tobacco revenue, besides creating newer job
opportunities. Warner and Fulton12 simulated the effect
of removal of tobacco from Michigan, USA, a non­
tobacco state, for the years 1992 through 2005, on the
number of jobs and tax revenues. The results indicated
that if there was no expenditure on tobacco products
and if this spending was redistributed to other goods
and services according to consumers' normal spending
patterns, (and to other taxes, to replace half of lost
cigarette excise tax revenues), Michigan would have
had 5600 more jobs in 1992 . By the year 2005,
a tobacco-free Michigan would still have almost 1500
more jobs. If, contemporary rate of decline in tobacco
consumption had doubled, the State would have had
over 300 more jobs in 1992 and would have nearly 800
more in 2005. The loss in tobacco revenue due to
elimination of tobacco, if not replaced, would have been
$254 million in 1992, but the loss due to doubling «。
the expected decline in smoking would have been $14
million during that year.

Some studies from developed countries have tried
to find the differentials in health care costs among
smokers and non-smokers. The categorization accord­
ing to smoking habit was made due to the fact that
smoking is the commonest tobacco habit in these coun­
tries. The 1992 report of the US Surgeon General stated
that the estimated average life time medical cost for a
smoker exceed those for a non-smoker by more than
$ 6,00013. A comparison of paid claims from a large
health insurance group*s indemnity plan in USA, from
January 1 to November 30, 1988, showed that tobacco
users had more admissions, longer average length of
stay, higher average outpatient payments ($ 122 vs $
75) and higher average insured payments ($ 1,145 vs
$ 762)". Due to the premature mortality among smok­
ers, insurance companies in USA charge higher for life
insurance of smokers. Three insurance companies owned
by the tobacco industry charge smokers nearly double
for life insurance, as smokers are twice as likely to die
as compared to non smokers (Time, October 12, 1992).
Estimates on cost of tobacco use (smoking) have
been made for many states of USA, indicating that the
losses to the country are substantial. Cummings et al15
estimated that in New ¥)rk State, USA, smokingattributable deaths comprised 17.7 per cent of all deaths.
Cigarette smoking was responsible fbr an average of
30,359 deaths, 409,129 years of productive life lost,
and nearly $4 billion in economic costs annually15.
Based on the assessment of the medical costs and lost
earnings due to tobacco smoking, the total cost of
smoking in Georgia during 1985 was $1.5 billion16.

Studies conducted in USA, Canada, Sweden, New
Zealand, Egypt, China and India, have estimated the
economic implications of tobacco use in the country.
Using demographic and epidemiologic data according
to accepted principles of health economics, the studies
have tried to estimate the direct and indirect morbidity
and mortality costs, due to use of tobacco. Comparison
of the existing health care costs with a hypothetical
situation where the Canadian society would be smoke
free, was one of the earliest of such exercises. The per
capita cost of health care for the year 1980, attributable
to tobacco smoking was $ 35.54 for males and $ 29.14
for females, or 15.17 per cent and 10.47 per cent of
the actual per capita costs for males and females,
respectively17. The health care costs associated with
smoxing would have been $ 2.4 billion in 1980, against
57

the income of $ 1 billion generated by tobacco during
the same year18.

the remaining cost was for excess prescription medi­
cines use and for general practitioner consultations24.

A report submitted to the American Cancer Society
estimated that the cost of medical and hospital bills due
to cigarette related illnesses in 1975, was about $15
billion, and the loss of income from lost workdays, due
to cigarette related illnesses amounts to $3 billion per
year. Balanced against the revenue of $12 billion due
to tobacco products in 1975, the cost of tobacco use
to the USA, amounted to $6 billion19. Another study
estimated the total financial cost of smoking to the US
society in 1990 as $2.59 per pack of cigarettes20.

In a single year, Sweden loses 29,000 working
person years owing to various smokers* illnesses while,
at the same time, smoking caused 3,900 cases of total
disability25. Another Swedish survey has estimated the
social costs of smoking at more than $660 million in
monetary terms for early eighties, with $135 million
for extra medical costs and $533 million for production
shortfalls26.

The progress on measures on control of tobacco is
being calculated in terms of the loss saved to the state/
country or in terms of the potential life years lost, due
to tobacco smoking. The number of years of potential
life lost due to tobacco in different states of USA, in
1990, ranged from 6,720 (Alaska) to 498,297 (Cali­
fornia). The proportion of smoking attributable mor­
tality to total deaths varied between 13.4 per cent
(Utah) and 24.0 per cent (Nevada), in different states21.
From January 1989, tax on cigarettes in California,
USA, was increased by 25C per pack, and 20 per cent
of this revenue was used for anti-smoking media cam­
paign and other educational programmes to reduce
tobacco use. The programme resulted in fall in the adult
smoking prevalence from 26 per cent in 1988 to 20 per
cent in 1993, which resulted in an estimated savings
of $386 million in direct medical costs in the state in
199322.

A recent study on the subject in USA, controlled
for ethnicity, poverty status, education, medical insur­
ance status, region, seat belt use, body mass index, and
chronic medical conditions, estimated the marginal
costs attributable to smoking. This was done on 35,000
US residents responding to the 1987 National Medical
Expenditure Survey, based on a multistage econometric
model and weighted to represent the US population
aged 19 years and above. The smoking attributable
direct costs amounted to $37.6 billion (6.7 % of the total
medical expenditures). Smoking attributable indirect
mortality costs were $41.4 billion23.
The total cost of cigarette smoking to the New
Zealand health services was conservatively estimated
at $185.4 million (in 1989 dollars). Most of this excess
cost ($128.3 million) was due to hospital care, and

58

Similar have been the resulU of exhaustive exer­
cises carried out in developing countries. The health
related economic costs caused by smoking in China,
in 1989, were estimated to be upto 27.1 billion Chinese
Yuan, compared to which the revenue from the tobacco
industry during 1989 was 24 billion Yuan. The direct
costs of smoking (medical expenses) were 6.94 billion;
the indirect morbidity costs were 2.58 billion; whereas
the indirect moru/ity costs amounted to 17.55 billion
Yuan27.

An analysis ofthe economic consequences of smoking
in Egypt in 1981/82 showed that 57,496 person years
were lost due to premature death as a consequence of
tobacco use. The direct and indirect costs to the country
due to tobacco use was 969.3 million LE, against a
benefit of 535.1 millionLE during the same year. Thus,
the loss to Egyptian society due to tobacco, in 1981/
82 was 434.2 million LE, which amounted to 91 per
cent of the taxes raised on tobacco products28.
Due to paucity of available information on the
economics of tobacco for India, the Indian Council of
Medical Research (ICMR), New Delhi is initiating
studies on measurement of costs for management of
tobacco related diseases. These include the estimation
of costs for management of tobacco related cancers,
coronary heart disease, and chronic obstructive lung
diseases.

The study on cost of management of tobacco related
cancers, raised a cohort of such patients and followed
them up periodically for three years or till death. At
the time- of firsi contact, the patients were interviewed
to find out the duration of the illness, and the efforts
made for diagnosis and treatment (specific or non­
specific) of the illness. The item-wise expenditure
incurred by the patients, or their relatives/friends, was

recorded. The items included fbr this purpose were the
expenditure on consultation, investigations, treatment,
transport for the purpose, and any additional cost
incurred for lodging and boarding. Enquiry was also
made to ascertain whether they incurreii any loss of
wages for treatment, of the disease, or if the disease
resulted in loss of their job. The patients have been
followed up till death or till a period of three years with
no evidence of disease after treatment. At each follow
up contact, information was collected item-wise, on
expenditure by the patients or their relatives/friends.

The studies on estimation of cost of management
of coronary heart disease and chronic obstructive lung
diseases, adopted a cross sectional approach and ob­
tained data on the annual expenses incurred by the
patients, their relatives/ friends. Data necessary to
estimate the expenditure by government on treatment
of tobacco related illnesses are also being collected.
The results of this study are likely to provide the much
needed objective information in the area, and would
help policy makers in decision making.
The studies on economics of tobacco generally
indicate that the costs incurred by society due to to­
bacco use more or less match the benefits received by
the society. Such calculations have not included the
costs of ecological effects of tobacco. If value is ac­
corded to these effects, the losses due to tobacco, to
the society would far outweigh the benefits. If tobacco
was to be introduced today in any society, it would be
impossible to get clearance from any controlling au­
thority in any country, The myth about economic
importance of tobacco has been a major factor in slow
actions for reduction in production of tobacco. It is
expected that studies on economics of tobacco would
help in breaking this myth.

5.

Notani, P.N., Jayant, K., and Sanghvi, L.D. Assessment of
morbidity and mortality due to tobacco usage in India. In:
Tobacco and Health: The Indian Scene. Eds. L.D. Sanghvi
and P.N. Notani. Tata Memorial Centre, Bombay, 1989, p.63.

6.

WHO. Controlling the smoking epidemic. WHO Tech Rep Ser
636: 29, 1979.

7.

MacKay, J. The economic implications of tobacco in
developing countries. In: Building a Tobacco Free
Wjrld — Proceedings cfthe 8th Nhrld Conference on Tobacco
or Health. American Cancer Society, USA, 1994, p.30.

8.

Lee, D.R. An economic analysis of the economic burden of
cigarette smoking in Georgia. J Med Assoc Ga 79:161,1990.

9.

Han, S.T. Tobacco or health: The western Pacific perspective.
In: The Global Wfar _ Proceedings of the Seventh ^forld
Conference on Tobacco and Health. Eds. B. Durston and K.
Jamrozik. Health Department of Western Australia, Perth,
990, p.63.

10.

Atkinson, A.B. and Townsend J.L. Economic aspects of
reduced smoking. Lancet ii: 492, 1977.

11.

Smoking and Health: A Study of the Effects of a Reduction
in Cigarette Smoking on Mortality and Morbidity Rates, on
Health Care and Social Security Expenditure and on Produc­
tive Potential. Her Majesty's Stationery Office, London,
1973.

12.

Warner, K.E. and Fulton, G.A. The economic implications
of tobacco product sales in a non-tobacco state. J Am Med
Assoc 271: 771, 1994.

13.

Smoking and Health in Americas. A 1992 Report of the
Surgeon General, in Collaboration with the Pan American
Health Organization (Executive Summary): Department of
Health and Human Services, Atlanta, 1992. (DHHS publica­
tion no. (CDC) 92-8421).

14.

Penner, M. and Penner, S. Excess insured health care costs
from tobacco-using employees in a large group plan. J Occup
Med 32: 521, 1990.

15.

Cummings, K.M., Stiles, J., Mahoney, M.C. and Sciandra R.
Health and economic impact of cigarette smoking in New
York State, 1987-1989. N Y State J Med 92: 469, 1992.

帼ssilak, S.G.F., Smith, D.J., McKinley, T.W, and Sikes,

16.

R.K. The health and economic burden of cigarette smoking
in Georgia in 1985. J Med Assoc Ga 78: 601, 1989.

References:
1.

Wamer, K.E. The tobacco subsidy: Docs it matter? J Natl
Cancer Inst 80: 81, 1988.

2.

Joossens, L and Raw, M. Tobacco and the European common
agricultural policy. Br J Addict 86: 1191, 1991.

3.
4.

Chaudhry, K. Control or promotion of tobacco — The para­
dox. Tobacco Control (SAARC edition) 1: 41, 1994.

Peto, R. and Lopez, A.D. Worldwide mortality from current
smoking patterns. In: The Global Wir — Proceedings of the
Seventh V^forld Conference on Tobacco and Health. Eds. B.
Durston and K. Jamrozik. Health Department of Wbstcm
Australia, Perth 1990, p.66.

17' Forbes, W.F. and Thompson, M.E. Estimating economic
benefits and losses associated with cigarette smoking. Can
J Pub Hllh 74: 183, 1983.

18. Forbes, W.F. and Thompson, M.E. Estimating the health care
x costs of smokers. J Can Med Assoc 127: 831, 1982.

19.

A National Dilemma: Cigarette Smoking or the Health of
Americans. Report of the National Commission on Smoking
and Public Policy, American Cancer Society, Inc., 1978.

20.

Smoking Related Deaths and financial Costs: Estimates for
1990. Office of Technology Assessment, Wastington DC,
1993.

59

21.

22.

23.

Nelson, D.E., Kirkendall, R.S., Lawton, R.L., Chrismon,
J.H., Merritt, R.K., Arday, D.A. and Giovino, G.A. Surveil­
lance for smoking-attributable mortality and years of potential
life lost, by state - United States, 1990. MMWR CDCSurveill
Summ 43: 1, 1994.
Bal, D.G. and Lloyd, J. Advocacy and government action
for cancer prevention in older persons. Cancer 74 (7suppl):
2067, 1994.
Novotny, T.E., Bartlett, J.A., Miller, L.S., Rice, D.P., Max,
W.B. and Merritt, R. The economic costs of smoking in the
United States, 1990 — Adjusted estimates from the national
medical expenditures survey. Abstract Book of 9th W>rld
Conference on Tbbacco and Health, (Abs No.SS 15/5) 1994,
p.45.

24.. Phillips, D.» Kawachi, I. and Tilyard, M. The costs of smoking
revisited. N Z Med J 105: 240, 1992.

25.

Silverfbrsen, L., Nygren, A. and Bolinder, G. The Swedish
Society of Medicine's and The Folksam Group's action programme
against the use of tobacco. In: The Global "War — Proceedings

ofthe Seventh Nhrld Conference on Tbbacco and Health. Eds.
B. Durston and K. Jamrozik. Health Department of Western
Australia, Perth, 1990, p.324.

26.

Pellmer-Wramner* K. and Wramner, B. Tobacco use in the
occupational health services. Review of General and Medical
Facts about Smoking and Health. (Swedish) Stockholm, 1983.

27.

Jin, S., Lu, B., Yan, D., Fu, Z., Jiang, Y. and Li, W. Smoking
attributable health costs in China (1988-89). Abstract Book
of 9th Vforld Conference on Tbbacco and Health, (Abs.
No.0328), 1994, p.134..

28.

Sheriff O. Tbn years after legislation. In: The Global VJar —
Proceedings ofthe Seventh "World Conference on Tbbacco and
Health. Eds. B. Durston and K. Jamrozik. Health Departmment
of Western Australia, Perth, 1990, p.157.

This write up, published on the occasion of Wsrld No
Tobacco Day (May 31, 1995) has been contributed by Dr. K.
Chaudhry, Asstt. Director-General, ICMR Headquarters,
New Delhi.

ABSTRACTS

Some Research Projects Completed Recently
Clinical and bacteriological study of dental caries in
children.

material from 53 matched controls, were studied for
the presence of microorganisms.

The study was carried out to determine the preva­
lence of dental caries in school children aged 10-15 yr
from different socio-economic strata. The bacterial
isolates, the serum and salivary immunoglobulins and
CMI responses to Streptococcus mutans, were also
evaluated in these children.

The incidence of Bacteroids melaninogenicus
assacharolyticus group.and aerobic Gram negative bacilli
was higher in controls as compared to children with
caries. There was no significant difference in the iso­
lation rate of Streptococcus mutans in patients and
controls.

Among the 1092 children studied, the prevalence
of dental caries was found to be 39.19 per cent with
an average mean DMFT (delayed, missing and filled
teeth) per child being 1.02. A significant relationship
was found between dental caries and the source of
drinking water, oral hygiene measures used, type of
cleaning agents used, frequency of cleaning and intake
of sweets. However, no significant relationship was
found between dental caries and the type of diet or the
type of sweets and the type and frequency of drinks.
The prevalence of caries was maximum at the age of
10 years.

Immunoglobulin levels were estimated in 379 chil­
dren (169 with low caries, 57 with high caries and 153
controls). Serum IgG levels were higher but salivary
levels were lower in carious children as compared to
controls. The serum IgA and IgM levels of patients and
controls were not significantly different. The salivary
IgA levels were lower in children with caries, whereas
salivary IgM levels were below detectable levels in both
children with caries and controls. Significantly high
levels of S. mutans specific serum IgG were found only
in children with high and low caries whereas specific
salivary IgG levels were more or less in the similar
range in children with low and high caries as well as
controls. S. mutans specific serum IgA levels were high
in children with caries compared to controls. An in­
teresting finding was that children with high caries

A total of 285 specimens comprising 116 specimens
each of dental plaque material and carious material
from children with dental caries and dental plaque
60

showed low levels of S. mutans specific salivary IgA
levels whereas those with low caries showed high levels
of specific salivary IgA. This clearly indicated that S.
mutans specific salivary IgA plays an important role
in protection against dental caries.
Cell mediated immunity was studied in 360 children
(160 with low caries, 45 with high caries and 155
controls). Low stimulation index was observed in case
of high caries while children with low caries showed
high stimulation index indicating that in case of recent
infection CMI plays an important role. The control
children revealed stimulation index levels between those
of children with low and high caries.

It is thus concluded that humoral and CMI immune
responses to S. mutans in dental caries play an impor­
tant role.
H. Parkash
Department of Dental Surgery
All India Institute of Medical Sciences
New Delhi.

Air oxygen as carrier gas in anaesthesia.

The study was carried out to determine the useful­
ness of air oxygen as carrier gas in balanced anaesthesia
technique.

selected for the study. Anaesthesia was given from the
Pedius B Usha Drager anaesthesia apparatus. The patients
were divided in two equal groups; one group on spon­
taneous ventilation and the other on controlled venti­
lation using pancuronium as per requirement of sur­
gery-

Clinical parameters remained within normal limits
during anaesthesia in both groups. Recovery in both
groups was good and the incidence of post-operative
complications was low. The awakening time was 5.12 +
0.57 min in patients breathing spontaneously compared
to 2.32 ± 0.84 min in those on controlled ventilation.
No patient had awareness of any intraoperative event.
The use of air as carrier gas may be superior to
nitrous oxide as the side effects encountered while
using nitrous oxide were not seen. Further, the Pedius
B machine can be easily operated in remote areas.
The disadvantage of using air as carrier gas was
in the form of loss of mild analgesic and anaesthetic
effects of nitrous oxide necessitating higher doses of
volatile and intravenous anaesthetics. The Pedius B
machine also had some disadvantages such as water
condensation, argon accumulation etc with the oxygen
concentrator.

G. Johar
T.K. Mitra
Department of Anaesthesia
Army Hospital
Delhi Cantt.

A total of 60 patients of both sexes in the age group
of 16-60 years with an ASA grading of I/II who were
to undergo anaesthesia for more than one hour were

ICMR NEWS
The following meetings of various technical groups/
committees of the Council were held:

PRC on Indo-German Proejct
on Cancer

Meetings of the Scientific Advisory Groups (SAGAs)/
Project Review Committee (PRC) held at New Delhi:

Participation of ICMR Scientists in Scientific Events:

SAG of the Division of Basic
Medical Sciences

April 17, 1995

SAG for Traditional Medicine
Research

April 18, 1995

SAG of the Division of Epidemiology
and Communicable Diseases

April 21, 1995

April 21, 1995

Dr. M.D. Gupte, Officer-in-Charge, CJIL Field
Unit for Epidemiology of Lq)rosy at Avadi, Madras,
participated in a joint meeting of Immunology (IMMYC)
and Chemotherapy (THEMYC) of Mycobacterial Dis­
eases as also the IV meeting of the THEMYC Steering
Committee at Geneva (April 24-27, 1995).
Dr. B.D. Nag, Dy. Director, Regional Occupational
Health Centre, Bangalore, participated in the XXVII
61

Session of the Codex Committee on Pesticide Residues
at the Hague (April 24 - May 1, 1995).

Dr. V.P. Sharma, Director, Malaria Research Cen­
tre, Delhi, participated in the Conference on Water
Resources; Health, environment and development at
Townsville (April 26-28, 1995). Dr. Sharma also par­
ticipated in the H meeting of the Panel of Experts on
Environmental Management (PEEM) Collaborating
Centres and PEEM Steering Committee meeting at
Brisbane (May 1-4, 1995).
Dr. Kamal a Krishnaswamy, Dy. Director (Sr. Grade),
National Institute of Nutrition, Hyderabad, participated
in the IV Expert Panel meeting of Diet and Cancer
Projects at Mexico (April 26-28, 1995).

Dr. ZM. Patel, Asstt. Director, ICMR Genetic
Research Centre, Bombay, participated in the XXIII
International Conference of Medical Women's Interna­
tional Association at the Hague (May 7-12, 1995).
Dr. G.V. Satyavati, Director-General, ICMR, vis­
ited Geneva for technical discussions for collaboration
between WHO and ICMR through the Special Programme
fbr Research and Training in Tropical Diseases (May
8-9, 1995). The DG, ICMR and Secretary ^Family
Welfare), Ministry of Health and Family Welfare, held
discussions for collaboration between the Government
of India and WHO Special Programme for Research in
Human Reproduction on Reproductive Health Research
(May 10-12, 1995).

COUNCIL'S TRAINING PROGRAMMES FOR 1995-96
Virology

At the National Institute of Virology, Pune:
•

•

M.Sc. in Applied Nutrition (June 1, 1995 - February
28, 1996).

•

Annual Training Course in Nutrition (December 1,
1995 - February 28, 1996).

Diploma in Medical Virology (June 1995 - May 1996).

Reproductive Biology

Oncology

At the Institutefor Research in Reproduction, Bombay:

•

Training Course on Techniques in Human Semenology
(May 15 - June 2, 1995).

At the Institute of Cytology and Preventive Oncology,
New Delhi:

•

Training Course on Techniques in Immunology, Cell
Biology and Molecular Biology (November2-25,1995).

・

•

Training Course on Techniques in Neuroendocrine Re­
search (February 6-10, 1996).

Endocrinology

At the National Institute of Nutrition, Hyderabad:
•

Annual Training Course on Endocrinological Tech­
niques and their Application (August/September, 1995).

Nutrition
At the National Institute of Nutrition, Hyderabad:

62

Workshop on Molecular Biology ofViruses and Cancer
alongwith Oligo DNA Synthesis and Polymerase Chain
Reaction (September 18-22, 1995).

Occupational Health

At the National Institute of Occupational Health,
Ahmedabad:

•

Orientation Course on Occupational Health for Indus'trial Medical Officers (November 13-24, 1995).

.

Training Course on Air Pollution Monitoring and Risk
Assessment (December 13-19, 1995).

Medical Entomology

Haematology

At the Vector Control Research Centre,Pondicherry:

At the Institute of Immunohaematology, Bombay:

.

M.Sc. in Medical Entomology (From August 1995: for
2 years).

•

Training Course in Blood Group Serology and Blood
Bank Methodology for Medical Officers (August 1 September 29, 1995).

•

Training Course in Blood Group Serology and Blood
Bank Methodology for Technicians (August 1-31,1995).

•

Training Course in Advanced Haematology and
Immunohaematology (September 11-29, 1995).

Laboratory Animal Technology

At the Laboratory Animal Information Services Centre,
National Institute of Nutrition, Hyderabad:

•

Training Course for Laboratory Animal Technicians
(June - July, 1995).

ICMR PUBLICATIONS

Price (Rs.)

•

|

Nutritive V^lue of Indian Foods (1985), by C. Gopalan, B.V Ramasastri and
S.C. Balasubramaniam, Revised and Updated (1989), by B.S. Narasinga Rao,
K.C. Pant and Y.G. Deosthale

21.00

Growth & Physical Development of Indian Infants and Children
(1972, Reprinted 1989)

10.00

Studies on Weaning & Supplementary Foods (1974, Reprinted 1986)

6.00

Studies on Pre-School Children (1974, Reprinted 1986)

6.00

A Manual of Nutrition (Second Edition 1974, Reprinted 1992)

4.50

Low Cost Nutritious Supplements (Second Edition 1975, Reprinted 1994)

4.00

Menus for Low Cost Balanced Diets and School Lunch Programmes Suitable
for. South India (Third Edition 1977, Reprinted 1991)

4.50

Menus for Low Cost Balanced Diets and School Lunch Programmes Suitable
for North India (Second Edition 1977, Reprinted 1994)

4.50

Some Common Indian Recipes and their Nutritive Value (Fourth Edition 1977,
Reprinted 1991) by Swaran Pasricha & L.M. Rebello

10.00

Nutrition for Mother & Child (Third Edition 1978, Reprinted 1991)
by P.S. Venkatachalam & L.M. Rebello

9.00

Japanese Encephalitis in India (Revised Edition 1980)

5.00

Some Therapeutic Diets (Fourth Edition 1988, Reprinted 1992) by Swaran Pasricha

4.50

Nutrient Requirements & Recommended Dietary Allowances for Indians
(1990, Reprinted 1994)

14.00
63

Fruits (1983, Reprinted 1992) by Indira Gopalan & M. Mohan Ram

7.00

Count What %u Eat (1989, Reprinted 1991) by Swaran Pasricha

9.00

Diet & Diabetes (Second Edition 1993) by T.C. Raghuram, Swaran Pasricha
& R.D. Sharma

18.00

Dietary Tips for the Elderly (1990, by Swaran Pasricha & B.V.S. Thimmayamma

3.50

Diet and Heart Disease (1994) by Ghafborunissa and Kamala Krishnaswamy

26.00

♦Depressive Disease (1986) by A. Venkoba Rao

58.00

**Medicinal Plants of India Vbl.2 (1987)

136.00

**The Anophelines of India (Revised Edition 1984) by T. Ramachandra Rao

150.00

*10' per cent discount allowed to individuals.
**25 per cent discount allowed to individuals.

These publications are available on prepayment of cost by cheque, bank draft or postal order (bank and postal
charges will be extra) in favour of the Director-General, Indian Council of Medical Research, New Delhi.
Money orders are not acceptable. All correspondence in this regard should be addressed to the Chief, Division
of Publication and Information, Indian Council of Medical Research, Post Box No.4911, Ansari Nagar, New
Delhi-110029 (India).

Editorial Board
Chairperson

Members

Dr. G.V. Satyavati
Director-General

Dr. Badri N. Saxena
Dr. C.R. Ramachandran

Editor
Dr. N. Medappa

Printed and Published by Shri J.N. Mathur for the Indian Council of Medical Research, New Delhi
at the ICMR Offset Press, New Delhi-110029
R.N. 21813/71

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