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	<title>oral &#8211; Fountain Magazine</title>
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		<title>Dental Care with Miswak</title>
		<link>https://fountainmagazine.com/all-issues/2019/issue-131-sep-oct-2019/dental-care-with-miswak/</link>
		
		<dc:creator><![CDATA[Louima Cunningham]]></dc:creator>
		<pubDate>Sun, 01 Sep 2019 21:48:50 +0000</pubDate>
				<category><![CDATA[Issue 131 (Sep - Oct 2019)]]></category>
		<category><![CDATA[antibacterial]]></category>
		<category><![CDATA[bacteria]]></category>
		<category><![CDATA[benzyl]]></category>
		<category><![CDATA[dental]]></category>
		<category><![CDATA[effect]]></category>
		<category><![CDATA[effective]]></category>
		<category><![CDATA[effects]]></category>
		<category><![CDATA[essence]]></category>
		<category><![CDATA[health]]></category>
		<category><![CDATA[hygiene]]></category>
		<category><![CDATA[miswak]]></category>
		<category><![CDATA[obtained]]></category>
		<category><![CDATA[oral]]></category>
		<category><![CDATA[picture]]></category>
		<category><![CDATA[practice]]></category>
		<category><![CDATA[prophet]]></category>
		<category><![CDATA[research]]></category>
		<category><![CDATA[roots]]></category>
		<category><![CDATA[Science]]></category>
		<category><![CDATA[sticks]]></category>
		<category><![CDATA[teeth]]></category>
		<category><![CDATA[tree]]></category>
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					<description><![CDATA[We all may appreciate the difference between the positive impact made by a smile of pearly-white teeth and the repulsion triggered by yellowed and blackened rotten teeth, but the health issues run much deeper: as our medical knowledge grows, we are discovering that many diseases originate from dental cavities where microbes teem and nest, causing [&#8230;]]]></description>
										<content:encoded><![CDATA[<p><img fetchpriority="high" decoding="async" class=" size-full wp-image-6766" src="https://fountainmagazine.com/wp-content/uploads/2019/09/10-ad7.jpg" alt="Dental Care with Miswak" width="1920" height="1200" srcset="https://fountainmagazine.com/wp-content/uploads/2019/09/10-ad7.jpg 1920w, https://fountainmagazine.com/wp-content/uploads/2019/09/10-ad7-300x188.jpg 300w, https://fountainmagazine.com/wp-content/uploads/2019/09/10-ad7-1024x640.jpg 1024w, https://fountainmagazine.com/wp-content/uploads/2019/09/10-ad7-768x480.jpg 768w, https://fountainmagazine.com/wp-content/uploads/2019/09/10-ad7-1536x960.jpg 1536w" sizes="(max-width: 1920px) 100vw, 1920px" /></p>
<p>We all may appreciate the difference between the positive impact made by a smile of pearly-white teeth and the repulsion triggered by yellowed and blackened rotten teeth, but the health issues run much deeper: as our medical knowledge grows, we are discovering that many diseases originate from dental cavities where microbes teem and nest, causing inflammations in many organs and tissues, most notably in the heart, kidneys, and joints.</p>
<p>The use of herbal sticks for cleaning teeth dates back to around 3500 BC, the time of the Babylonians. In several works of Ancient Greek and Roman literature, chewable sticks to aid dental and mouth hygiene are mentioned [1]. Hippocrates (355 BC) advises rubbing a ball of cotton wrapped around a stick and dipped in honey on teeth, to maintain dental hygiene, whereas Romans used pastes obtained from gumwood [2]. Dental hygiene is coming throughout history.</p>
<p>Arabs utilized the <em>miswak</em> for many years [3]. The Japanese used wooden sticks called “<em>koyoji</em>” and Jews used wooden sticks called “<em>kesam.</em>” In the 1920s, in some rural areas across the United States, a stick of blood-twig was used for rubbing on the teeth [3]. And according to a Chinese encyclopedia published in the seventeenth century, the first-ever toothbrush was made in China, in 1498.</p>
<p>Prophet Muhammad, peace be upon him, warned those of his Companions who visited him with bad teeth about the need for dental hygiene (Ahmad ibn Hanbal, Musnad 1/214):</p>
<p>“I oft reiterated my recommendations to you about the <em>miswak.</em>” (Bukhari, Jum’a 8; Nasai, Taharah 5; Ahmad ibn Hanbal, Musnad 3/143; Darimi, Wudhu’ 18)</p>
<p>“(The Archangel) Gabriel counseled me to use the <em>miswak</em> so much that I thought a verse might be revealed about the <em>miswak</em> to decree its use as obligatory for all.” (Ibn Majah)</p>
<p>Obviously he assigned the utmost importance to dental hygiene. It should be noted here that the <em>Araq</em> tree (<em>Salvadora persica</em>) from which the <em>miswaq</em> is obtained has features that are not present in other trees, and the Prophet particularly specified using the roots of that tree as the <em>miswak</em>.</p>
<p>Research has been conducted to discover the scientific and modern medicinal effects of the <em>miswak</em>, which has been used by Muslims in adherence to the Prophet’s practice. In 2010, a Ph.D. study at Karolinka Institute, Sweden, provided a significant message about its effectiveness [4] (Picture 1).</p>
<p>The <em>Araq</em> tree, which is used as the <em>miswak</em> across a geography spanning from Africa to the far east, is a short tree or bush with a slanted trunk, and it is easy to chew its spongy roots, parts of which generally expand and soften when dipped in water (Picture 2).</p>
<p>The roots of the <em>Araq</em> tree are washed to remove the soil, and approximately 1 cm from the tip of the root stick is peeled to be used as the toothbrush. The stick is pummeled or chewed until the fibers become softer (Picture 3). Fresh and soft <em>miswak</em> are preferable: If the <em>miswak</em> is dry, it is advised to dip it in freshwater for 24 hours before use. It is better to peel frequently, so the tip is renewed. The most practical advice is to use the peeled tip until it loses its tang and fragrance, because the fragrant components indicate the beneficial effect of the <em>miswak</em>. According to a study, using the same tip for more than 24 hours lowers its cytotoxic ability to get rid of microbes.</p>
<p>The practice of using <em>miswak</em> in the Muslim World is widespread in Asia, Africa, and some regions in the Middle East. As many Muslims opt for <em>miswak</em> use to maintain a practice of the Prophet, the World Health Organization (WHO) also advises and encourages the use of <em>miswak</em> as an effective dental hygiene tool along with the conventional toothbrush. The <em>miswak</em> is easy to use and effective; it also has chemical properties that help control dental plaque. Based on the basic information we have about the <em>miswak</em>, we can easily say that deeper research is needed for its different components, like its fibers, essence, and essential oils.</p>
<h3>Antibacterial effects of the <em>miswak</em></h3>
<p>The antibacterial activities of the essences obtained by crushing different roots of the <em>miswak</em> have been analyzed by microbiological techniques. It was discovered that the <em>miswak</em> essence has a very strong antibacterial effect, predominantly against Gram-negative bacteria, including mouth-cavity microbes like <em>Porphyromonas gingivalis</em> and <em>Aggregatibacter actinomycetemcomitans</em>. Two additional studies conducted on five different types of bacteria i.e. <em>Streptococcus mutans, S. faecalis, S. aureus, Haemophilus influenzae, Salmonella enterica</em>, and <em>Candida albicans</em>, and a type of fungus [5, 6, 7, 8] revealed that the <em>miswak</em> essence stops the reproduction of micro-organisms, has a lower effect on <em>Lactobacillus acidophilus</em>, is active against <em>Herpes simplex</em> virus which causes blistered lesions, and suppresses acid production.</p>
<p>The essential oil obtained from <em>miswak</em> essence includes 70% benzyl isothiocyanate, 9.4% limonene, 8.7% I-pinene and 2.55% flavonoid. As the <em>miswak</em>’s main antibacterial component, benzyl isothiocyanate kills bacteria by forming protrusions on their cell membranes. The volatile nature of this substance may open doors to new practices requiring antibacterial treatment. It has been proven that fresh <em>miswak</em> is effective at preventing the formation of dental plaque and gum inflammation, and it has also been acknowledged that it may play a potential role in preventing periodontal diseases.</p>
<p>The <em>miswak</em> essence hinders acidic (pH) conditions causing tartar and dental plaque, leads to a long-term increase of pH in the mouth, stimulates saliva flow in the <em>parotid</em> glands (located in front of both ears), and prevents tartar formation.</p>
<p>It is necessary to conduct further lab and clinical research to augment the positive results shown so far about the effects of the <em>miswak</em> against the inflammation of the palate and gums, as well as its antiviral and antifungal activities. Some research has additionally suggested that the <em>miswak</em> has antioxidant, analgesic, and anti-inflammatory effects. It is claimed that potassium chloride, <em>salvadourea </em>(a urea derivative), alkaloids, and oleic and linoleic acids in the <em>miswak</em> sap increase the viscosity of saliva, helps it to soak into hard-to-reach corners in the mouth, and contributes to overall dental hygiene. It is reported that a substance named Xylitol in the <em>miswak</em> essence suppresses acid production and the reproduction of mutant streptococci [9, 10].</p>
<h3>An interesting substance in the <em>miswak</em> oil</h3>
<p>Benzyl-isothiocyanates are effective molecules in the defense systems of several plants such as cabbage, watercress, and broccoli. Secreted after damage to plant tissues, benzyl isothiocyanate forms a protective antibacterial layer on the damaged part of the plant. While dental plaque and tartar are mechanically removed by rubbing the <em>miswak</em> on teeth, this action also helps the substance secreted from the <em>miswak</em> reach deeper parts of the oral cavity. It is especially proven that benzyl isothiocyanates are strongly effective as bactericide on Gram-negative bacteria and have minimal effect on Gram-positives.</p>
<p>Lab tests conducted on animals indicate that these components also have anti-carcinogenic activity, and people who get isothiocyanates by nutrition have a lower risk of cancer. It is fascinating that the <em>miswak,</em> too, has the same substance.</p>
<p>While introducing a new set of ethical principles, Prophet Muhammad, peace be upon him, revoked some customs and habits inherent to the pagan culture before Islam (Age of Ignorance) and kept others. Using <em>miswak</em> was a practice among the Arabs in the region; the Prophet encouraged its use and emphasized its benefits. Eventually, Muslims have adopted it as not only a habitual practice, but also as a healthy spiritual activity and are keeping the memory of the Prophet alive.</p>
<h3>References</h3>
<ol>
<li>Wu, C.D., Darout, I.A. and Skaug, N. (2001): Chewing sticks: timeless natural toothbrushes for oral cleansing. <em>Journal of Periodontal Research 36, 275-84.</em></li>
<li>Hyson, J.M., Jr. (2003): History of the toothbrush. <em>Journal of the History of Dentistry 51, 73-80</em>.</li>
<li>Bos, G. (1993): The Miswak, an aspect of dental care in Islam. <em>Medical History, 37, 68-79</em>.</li>
<li>Sofrata, A. H. (2010): <em>Salvadora persica</em> (Miswak). An effective way of killing oral pathogens. Thesis for doctoral degree (Ph.D.). From the Division of Periodontology, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.</li>
<li>Al-Lafi, T. and Ababneh, H. (1995): The effect of the extract of the Miswak (chewing sticks) used in Jordan and the Middle East on oral bacteria. <em>International Dental Journal, 45, 218-222.</em></li>
<li>Almas, K., Al-Bagieh, N. And Akpata, E. (1997): In vitro antimicrobial effect of extracts of freshly cut and 1-month-old miswak (chewing sticks). <em>Biomedical Letters, 56, 145-149</em>.</li>
<li>Almas, K. (1999): The antimicrobial effects of extracts of Azadirachta indica (Neem) and Salvadore persica (Arak) chewing sticks. <em>Indian Journal of Dental Research, 10, 23-26</em>.</li>
<li>Almas, K. (2001): The antimicrobial effects of seven different types of Asian chewing sticks. <em>Odontostomatolgie Tropicale, 24, 17-20</em>.</li>
<li>Kakuta, H., Iwami, Y., Mayanagi, H. and Takahashi, N. (2003): Xylitol inhibition of acid production and growth of mutans <em>Streptococci</em> in the presence of various dietary sugars under strictly anaerobic conditions. <em>Caries Research, 37, 404-409</em>.</li>
<li>Miyasawa, H., Iwami, Y., Mayanagi, H. and Takahashi, N. (2003): Xylitol inhibition of anaerobic acid production by Streptococcus mutans at various pH levels. <em>Oral Microbiology and Immunology, 18, 215-219</em>.</li>
</ol>
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		<item>
		<title>Science Square (Issue 129)</title>
		<link>https://fountainmagazine.com/all-issues/2019/issue-1298-may-jun-2019/science-square-issue-129/</link>
		
		<dc:creator><![CDATA[The Fountain]]></dc:creator>
		<pubDate>Wed, 01 May 2019 23:35:15 +0000</pubDate>
				<category><![CDATA[Issue 129 (May - Jun 2019)]]></category>
		<category><![CDATA[Artificial photosynthesis]]></category>
		<category><![CDATA[brain]]></category>
		<category><![CDATA[ceiling]]></category>
		<category><![CDATA[co2]]></category>
		<category><![CDATA[efficient]]></category>
		<category><![CDATA[energy]]></category>
		<category><![CDATA[fuel]]></category>
		<category><![CDATA[gut]]></category>
		<category><![CDATA[immune]]></category>
		<category><![CDATA[intestines]]></category>
		<category><![CDATA[opa]]></category>
		<category><![CDATA[oral]]></category>
		<category><![CDATA[photosynthesis]]></category>
		<category><![CDATA[process]]></category>
		<category><![CDATA[reactions]]></category>
		<category><![CDATA[researchers]]></category>
		<category><![CDATA[responses]]></category>
		<category><![CDATA[Science]]></category>
		<category><![CDATA[Science Square]]></category>
		<category><![CDATA[scientists]]></category>
		<category><![CDATA[segments]]></category>
		<category><![CDATA[sense]]></category>
		<category><![CDATA[water]]></category>
		<guid isPermaLink="false">http://107.21.79.195/all-issues/2019/issue-1298-may-jun-2019/science-square-issue-129/</guid>

					<description><![CDATA[Artificial photosynthesis transforms CO2 into liquefiable fuels Yu and Jain. Plasmonic photosynthesis of C1–C3 hydrocarbons from carbon dioxide assisted by an ionic liquid. Nature Communications, May 2019. Scientists have recently established a reliable “artificial photosynthesis” paradigm to produce fuels from water, carbon dioxide, and visible light. With the help of sunlight, chemical reactions between water [&#8230;]]]></description>
										<content:encoded><![CDATA[<p><img decoding="async" class=" size-full wp-image-6718" src="https://fountainmagazine.com/wp-content/uploads/2019/05/tech1-d31.jpg" alt="Science Square (Issue 129)" width="1920" height="1200" srcset="https://fountainmagazine.com/wp-content/uploads/2019/05/tech1-d31.jpg 1920w, https://fountainmagazine.com/wp-content/uploads/2019/05/tech1-d31-300x188.jpg 300w, https://fountainmagazine.com/wp-content/uploads/2019/05/tech1-d31-1024x640.jpg 1024w, https://fountainmagazine.com/wp-content/uploads/2019/05/tech1-d31-768x480.jpg 768w, https://fountainmagazine.com/wp-content/uploads/2019/05/tech1-d31-1536x960.jpg 1536w" sizes="(max-width: 1920px) 100vw, 1920px" /></p>
<h3><strong>Artificial photosynthesis transforms CO<sub>2 </sub>into liquefiable fuels</strong></h3>
<p><u>Yu and Jain. Plasmonic photosynthesis of C1–C3 hydrocarbons from carbon dioxide assisted by an ionic liquid. Nature Communications, May 2019.</u></p>
<p>Scientists have recently established a reliable “artificial photosynthesis” paradigm to produce fuels from water, carbon dioxide, and visible light. With the help of sunlight, chemical reactions between water and CO<sub>2</sub> are catalyzed in plants to generate and store solar energy in the form of glucose. This process is called photosynthesis. In the new study, the researchers developed an artificial process that uses the same mechanisms of natural photosynthesis to convert CO<sub>2</sub> and water into liquid fuel by using electron-rich gold nanoparticles as a catalyst. Gold nanoparticles function in the same role as chlorophyll in natural photosynthesis in the absorbing of light and transferring electrons and protons to catalyze the chemical reactions between CO<sub>2</sub> and water. They are known to be efficient at absorbing light and do not break down or degrade like other metals. The energy stored in the bonds of the hydrocarbon fuel can be freed by the conventional method of combustion or by new-generation, environmentally-friendly power fuel cells, thus producing electrical current. By converting CO<sub>2 </sub>into more complex molecules like propane, green-energy technology is now one step closer to using excess CO<sub>2</sub> to store solar energy for use when the sun is not shining and in times of peak demand. While the development of this CO<sub>2</sub>-to-liquid fuel may be exciting for proponents of green-energy technology, the artificial photosynthesis process is nowhere near as efficient as it is in plants. New methods should be developed to increase the efficiency of the catalysts and downstream chemical reactions at much higher scales.</p>
<h3><strong>Brain area that watches for walls identified</strong></h3>
<p><u>Henriksson et al. Rapid Invariant Encoding of Scene Layout in Human OPA. Neuron, May 2019.</u></p>
<p>Neuroscientists have identified the part of the human brain whose duty is to help us perceive the barriers which define the navigable space around us, such as walls or ceilings, so that so we can avoid bumping into things and navigate safely through our environment. By way of vision we have an almost instant sense of where we are in space. Although this process feels effortless, it requires the coordinated activity of multiple brain regions and neurons working together to give us this sense of our surroundings. This process has remained unknown. But thanks to a new study, we are a step closer to solving the puzzle. Using cutting-edge brain-imaging technologies, researchers examined the mental responses of volunteers as they were shown images of various three-dimensional scenes. The images depicted a typical room with three walls, a ceiling, and a floor, but then were abruptly changed by the removal of a wall or a ceiling. By doing this repeatedly, the team could pinpoint how the participant’s brain encoded every scene. In the brain scans of the volunteers, one brain area called the occipital place area (OPA) clearly stood out. OPA activity represented the geometry of the scenes and activity patterns, reflected the presence or absence of each component, such as a ceiling or a wall, and projected a detailed picture of the overall configuration. Interestingly, OPA seemed to ignore the surface appearance of the various components such as colors or textures in order to focus only on the geometric patterns. The OPA managed to perform all the necessary computations needed to get a sense of a room&#8217;s layout extremely fast – in just 100 milliseconds. In the future, the research team plans to incorporate virtual reality technology to create more realistic 3D environments for participants to experience, hopefully achieving much deeper insights into how our brains process and makes sense of the visual information.</p>
<h3><strong>Gut segments are organized by function</strong></h3>
<p><u>Esterházy D. et al. Compartmentalized gut lymph node drainage dictates adaptive immune responses. Nature, April 2019.</u></p>
<p>As food enters our intestine, it goes through a windy and lengthy journey. A new study provides new insights into how our intestines maximize nutrient uptake while protecting the body from potentially dangerous invading microbes. At first glance, the intestines appear to have a uniform tissue structure. But when scientists looked at them closer, they found that our food-processing canal seems to consist of multiple compartments that pace the immune system&#8217;s reactions to the food passing through. Scientists uncovered these functional intestine segments in mice when they examined the intestinal structures called gut draining lymph nodes, which orchestrate immune responses. The researchers found that nodes in different parts of the intestines had different cell composition, and they saw different immune responses between segments when they challenged the mice with a pathogen. They observed less aggressive defenses in the first segments where nutrients are absorbed, and more forceful responses at the end, where pathogens are eliminated. Researchers plan to exploit these immunological differences between the gut segments for treating gastrointestinal disorders. For example, by targeting immune-suppressing drugs to the specific gut segment where they&#8217;ll have the most effect, it might be possible to dampen their side-effects. The spectrum of immune responses along the intestines could also be used to make new and better oral vaccines. Thus far, scientists&#8217; efforts to design oral vaccines have been hampered by the difficulty of generating a robust immune response; it is possible that the muted immune response at the beginning of the intestines might be part of the reason why oral vaccines tend to be less effective than injections. Thus, targeting the distant end of the intestine might be much more efficient way of inducing the immune response required.</p>
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		<item>
		<title>Tobacco And Cancer: Moral Teachings and Cancer Prevention</title>
		<link>https://fountainmagazine.com/all-issues/1995/issue-11-july-september-1995/tobacco-and-cancer/</link>
		
		<dc:creator><![CDATA[Louima Cunningham]]></dc:creator>
		<pubDate>Sat, 01 Jul 1995 00:00:00 +0000</pubDate>
				<category><![CDATA[Issue 11 (July - September 1995)]]></category>
		<category><![CDATA[cancer]]></category>
		<category><![CDATA[cancers]]></category>
		<category><![CDATA[cigarette]]></category>
		<category><![CDATA[cigarettes]]></category>
		<category><![CDATA[health]]></category>
		<category><![CDATA[Health & Medicine]]></category>
		<category><![CDATA[lung]]></category>
		<category><![CDATA[men]]></category>
		<category><![CDATA[oral]]></category>
		<category><![CDATA[risk]]></category>
		<category><![CDATA[smoke]]></category>
		<category><![CDATA[smokers]]></category>
		<category><![CDATA[smoking]]></category>
		<category><![CDATA[tobacco]]></category>
		<category><![CDATA[women]]></category>
		<category><![CDATA[world]]></category>
		<guid isPermaLink="false">http://107.21.79.195/all-issues/1995/issue-11-july-september-1995/tobacco-and-cancer/</guid>

					<description><![CDATA[Introduction It is estimated that 80 to 90 percent of all cancer cases are related to environmental and lifestyle influences (1). Many cancer research centers estimate that 80 to 90 percent of human cancers are preventable. Beside chemicals and infections (viral and parasitic), extrinsic factors include diet among a variety of other factors wholly or [&#8230;]]]></description>
										<content:encoded><![CDATA[<h3><b>Introduction</b></h3>
<p>It is estimated that 80 to 90 percent of all cancer cases are related to environmental and lifestyle influences (1). Many cancer research centers estimate that 80 to 90 percent of human cancers are preventable. Beside chemicals and infections (viral and parasitic), extrinsic factors include diet among a variety of other factors wholly or partly determined by personal behaviour. Though genetic factors and age affect cancer onset rates, the conclusion holds that many human cancers are avoidable (2). A great number of these are related to tobacco smoking and chewing, alcohol consumption, homosexuality, promiscuity and excessive exposure to solar radiation as in sunbathing, all practices disapproved in traditionally religious societies.</p>
<p>Dr John Hill, a London physician, reported an increase of lip cancer in pipe smokers as long ago as 1761. Sir Percival Pott reported cancer of the scrotum in chimney sweeps in 1777, which he attributed correctly to lodgement of soot in the rugose scrotal skin. This type of cancer was virtually eliminated by simple personal hygiene (3). Later, many chemicals were proved to be carcinogenic and hence many cancers became avoidable by taking more care when dealing with them. Ionizing radiation is still an important hazard, preventable by taking better care.</p>
<h3><b>Tobacco and Cancers</b></h3>
<p>In many countries cancer is the second most important cause of death. In the USA and many developed countries, it accounts for 20 percent of all deaths (1,2). An estimated 6 million new cases of cancer occur annually worldwide, of which about a million are caused by tobacco smoking and chewing (4). The death toll due to malignant disease in the USA amounts to 400-450,000 annually of which 100,000 are due to lung cancer, 85 to 90 percent of those due to cigarette smoking (1,2). Indeed, tobacco (smoked, chewed or sniffed) is the most important single factor in cancer causation generally, responsible for 30- 40 percent of all cancers (5). No other single agent has been examined in more detail, nor more firmly established as a causal agent, than cigarette smoking (6). Let us look at some of the facts.</p>
<p>The risk of cigarette smokers developing lung cancer increases with the number of cigarettes smoked the duration of smoking, the time of onset and the type of smoking. Approximately one-sixth of those who smoke two packs of cigarettes per day will eventually develop lung cancer. The risk to hose who smoke 40 cigarettes per day are 25 times more that to non-smokers (6-8). Cigarette smoking causes all ol the major types of lung cancer including squamous cell carcinoma, adeno carcinoma, oat cell and large cell carcinoma (6). Cancer of the lung was a rare form of cancer at the beginning of this century, even in developed countries. As smoking increased dramatically after World War I among men, and among women after World War II, the incidence of cancer of the lung showed incessant increase until the seventies, after which it began to decline among men and a decade later among women. Nevertheless, cancer of the lung is still the first killing cancer among men and women in many developed and developing countries (7,9,13). In Hong Kong, the rates for women are now the highest in the world (13). Lung cancer rates in Chinese men (e.g. 50.2 per 100.000 in Shanghai) are higher than in many North American and European populations (13). It is the leading cause of cancer mortality among males in Bulgaria. Cuba, Czechoslovakia, Egypt, Greece, Hong Kong. Hungary, Israel, the Philippines, Poland, Romania, Singapore, Thailand, Uruguay and Zimbabwe. The risk is particularly high among cigarette smokers, and a clear cut dose-response relationship has been confirmed. The risk is greater among those who started smoking at a young age and those who smoke high tar cigarettes (2,14-16).</p>
<p>Laryngeal cancer is the second cancer caused by cigarette smoking, but the total number of cases is smaller than lung cancer and the survival is much better (6). Cigarette smokers are five times more likely to develop cancer of the oral cavity and the oesophagus than non-smokers (&amp;-8). There is synergism between alcohol and cigarette smoking in causing cancer of the larynx oesophagus and oral cavity(6-8.14-16,22).</p>
<p>Cigarette smoking is also an important contributing factor in cancers of the bladder, kidney and pancreas. Association between gastric cancer and smoking has also been noted (23-26). Cigarette smoking has even been implicated in cancers affecting the breasts, kidneys, liver, cervix, uteri and many other organs (27-29). It has also been implicated in childhood cancer as a result of prenatal exposure to parental smoking (30). Passive smoking was implicated in causing many cases of cancer (31-33).</p>
<h3><b>Non-smoked Tobacco</b></h3>
<p>Long term use of chewing tobacco or snuff has been linked to cancer of the oral cavity, cheek, gums and oropharynx (6). Oral cancer is one of the ten most common cancers in the world. In Bangladesh, India, Pakistan and Sri Lanka, it is the most common malignant disease and accounts for a third of all cancers. More than 100,000 new cases occur annually in South and South East Asia (13). The commonest cause for oral cancer is tobacco chewing, usually in the form of betel quid which consists of betel vine leaf (piper betel), areca nut, lime and tobacco (13,34). Tobacco chewing is also widespread in parts of Yemen, Sudan and Southern Province of Saudi Arabia: the so called &#8216;shamma&#8217; is a tobacco plus lime and ash mix, implicated in many cases of oral cancer in these areas (35,36).</p>
<p>Tobacco was propagated in developed countries by tobacco companies after the decline of cigarette smoking there. The 39th World Health Assembly in 1986 adopted Resolution WHA39 which declared that &#8216;the use of tobacco in all its forms is incompatible with the attainment of health for alt by the year 2000&#8217; (37). The study group concluded that the use of smokeless tobacco caused cancers in humans, the evidence of causality being strongest for cancers of the oral cavity. It also increased the risk of cancers of the nasal cavity, pharynx, larynx, oesophagus, pancreas and urinary tract. Laboratory studies clearly supported the observations that smokeless tobacco caused a number of precancerous oral lesions (37).</p>
<h3><b>Carcinogens in Tobacco Smoke</b></h3>
<p>Tobacco smoke is an aerosol consisting of about 2000 different substances, 50 of which are already proven to be human carcinogens e.g. Benza pyrines, Benza anthracene, Benzo floaranthene, Benzene and other Benzyl derivatives, cadmium, chrysene, methylchryscne, methyl fiouranthene and nitroso compounds (38,39).</p>
<p>Cigarette smoke also contains significant amounts of radioactive substances e.g. thorium Th228, polonium-210 and radium-Rd226. These compounds lodge in the lungs where they constantly irradiate the nearby cells and hence facilitate malignant change (38). Even the urine of cigarette smokers contains mutagenic substances for bacteria, and substances that cause changes in the chromosomes of human cells in tissue culture.</p>
<p>Sidestream smoke which is inhaled by non-smokers contains fifty fold greater concentration of nitrosamines than mainstream smoke. In one hour of breathing in a smoke filled room, a non-smoker may inhale an amount of nitrosamines equivalent to the amount inhaled after having smoked 15 filter cigarettes (38).</p>
<h3><b>Cessation of Smoking</b></h3>
<p>The risk after cessation of smoking decreases dramatically. Light smokers approximate the risk of nonsmokers after 10 to 15 years of cessation of smoking, while heavy smokers have a residual two to three fold increase after cessation (2,6). The mechanism of lung carcinogenesis and smoking cessation has been extensively studied (40).</p>
<p><b>Women and Smoking</b></p>
<p>As women started smoking long after men, there is a time lag in the incidence of lung cancer. The incidence of lung cancer has already fallen for men in most developed countries while it was still increasing for women early in the eighties. In 1984, 32 percent of the women smoked in Britain compared with 36 percent of men. In 1961, the figures had been 60 percent of men, and 40 percent of women. Whereas in 1950 the average woman smoker smoked half as many cigarettes as the average male smoker, in the eighties the corresponding figures were 14 and 16 cigarettes (41).</p>
<p>During the second decade of the anti-smoking campaign in Britain, smoking started to fall among women too, slowly at first, but with accelerating momentum (42). Similar trends are found in all developed countries, In some countries e.g. Australia, smoking among young and middle aged women was rising in the early eighties (5,43A4). The proportion of male smokers was falling in 19 out of 22 developed countries, and for women rising or stable in II countries (42-44). In Austria, Germany, Italy, Japan, U.S.S.R., smoking among women was still rising in the early eighties(42).</p>
<p>We may note that lung cancer has already surpassed breast cancer in the number of fatalities it causes. Non-smoking wives of smoking husbands (passive smokers) and non-smoking women working in smoking environments are also afflicted with lung cancer(6,31-33.37).</p>
<h3><b>Trends in Developed and Developing Countries</b></h3>
<p>Anti-smoking campaigns have been launched in the developed countries in the last three decades with tremendous achievements. In Britain, 60 percent of men were smokers in 1961 (the year before the first report of the Royal College of Physicians about smoking was published). By 1971 this figure had dropped to 47 percent, by 1984 to 36 percent, and by 1992 less than 25 percent of the adult males are smoking. As already noted, a similar trend among women smokers was apparent with a ten-year lag (42-45). The decline in cigarette consumption in other European countries and the USA has been comparable. By the mid-eighties sales had plummeted by an impressive 2$ percent with a 5-10 percent annual decline (42-44).</p>
<p>How have the tobacco companies been selling the 10 billion cigarettes they produce daily? By promoting sales in the poor Third World, already suffering from serious health hazards. Consumption of tobacco in Third World has seen a horrendous increase. The World Health Organization (WHO) has reported that tobacco related diseases are on the rise in developing countries.</p>
<p>During the last three decades: in Senegal the percentage of men who smoke in urban areas has reached an unprecedented 80 percent in Bangladesh 70 percent; in Lagos 72 percent of the Faculty of Medicine male students were smoking (46). Statistics from the Chamber of Commerce of Saudi Arabia show an unbelievable increase in tobacco imports: over 4,5 million kgs in 1972: over 27 million kgs in 1977; nearly 36 million kgs in 1981; 42 million kgs in 1984 &#8211; an increase of 900 percent (47-48). It is no surprise to find that lung cancer in Saudi Arabia has increased dramatically &#8211; from the twelfth most common cancer in a 1950-61 study (49) to the third most common cancer in a 1979-84 study (50). It is expected to be the leading cancer in the nineties us the effects of smoking are unfolding.</p>
<p>The tobacco companies&#8217; methods are unscrupulous as well as aggressive, with bribery of government officials to permit promotion not unusual. In 1982, the head of the Malaysian parliament retired and went to work as a chairman of Rothman&#8217;s, Malaysia&#8217;s largest cigarette manufacturer (48-51). Ethiopia imported 200 million expensive British cigarettes in 1984 when a large portion of its population were starving to death (52). In Bangladesh, smoking of five cigarettes daily robs the family of a quarter of its food supply, which results in an estimated 18.000 deaths among children annually (53). Unfortunately, the World Bank and Western Governments are co-operating with the seven giant tobacco companies (three American, three British and one French). The World Bank has given Pakistan 60 million dollars in loans to raise tobacco and the US Food for Peace Programs have spent 2 billion dollars in loans to developing countries for the purchase of U.S. tobacco and to establish joint-venture tobacco projects and factories (48-51). Tobacco needs to be cured with heat, obtained by burning wood. This results in deforesting 7 million acres annually with the obvious detrimental impacts on the local ecology, Heavy use (without protective measures) of carcinogenic pesticides on tobacco plantations has also resulted in many fatalities.</p>
<p>Neither tobacco promotion nor high tar content are restricted in many third world countries. Cigarettes smoked in China. India. Pakistan. Sri Lanka the Philippines etc. contain 21-33mg tar and 2-3mg nicotine: while in tile developed countries of U.S.A., Canada, Western Europe, the maximum legally permitted levels are 15 mg tar and 1 mg nicotine (13,46,48).</p>
<p>China consumes one third of the world&#8217;s production of cigarettes, while the other developing countries consume another third (48,54). The Eastern and Western block combined consume the remaining third.</p>
<p>The WHO emphasizes the need for a ban on tobacco promotion which should be comprehensive, fully implemented, well publicized, given major priority by governments and health authorities, and sustained on a long term basis (13).</p>
<h3><b>Islamic Law and Tobacco</b></h3>
<p>Muslim muftis and grand &#8216;ulama&#8217; proscribed smoking tobacco soon after it was introduced to Turkey around 1000H (1573). Sultan Murad of the Ottoman Caliphate made it a capital offence in 1663. The former Grand Mufti of Saudi Arabia, Sheikh Mohammed bin Ibrahim (55) included in his fatwa the names (If many grand &#8216;ulama&#8217; and muftis who had proscribed tobacco use since its first appearance in Turkey, Morocco, Egypt, Syria, and Yemen (56). All the religious authorities in Saudi Arabia, including of course the present Grand Mufti, Sheikh Abdul Aziz bin Baz, prohibited tobacco use, its promotion, sale, cultivation or dealing with it in any way other than destroying it.</p>
<p>Recently the 1st International Islamic Conference of ulama&#8217; (On Drugs, Narcotics and Liquors held in Madina, March 22-25, 1982, under the auspices of Crown Prince Abdullah bin Abdul Aziz passed a resolution prohibiting the use of tobacco in any of its forms, its cultivation, manufacture, trading in. selling or promoting it in any way (57). The WHO Eastern Mediterranean office published a book in 1988 under the title Al-Hukm al-Shar&#8217;i fi at-Tadkhin (Islamic legal ruling on smoking) which involved the decision of the ten leading &#8216;ulama&#8217; of Egypt, including Sheikh Al-Azhar, who explicitly considered tobacco use as haram (58).</p>
<p>The grounds for these judgments were:</p>
<ol>
<li>Smoking is detrimental to health. The Qur&#8217;an states clearly <em>Don&#8217;t kill yourselves (4.29) and Make not your own hands contribute to your destruction (2.195).</em> Islamic teachings generally, as well as hundreds of sayings of the Prophet, upon him be peace, encourage Muslims to preserve good health and abstain from things injurious to health.</li>
<li>Tobacco use wastes huge sums of money. Saudi Arabia spends annually more than one billion riyals on tobacco imports (59). Some poor Muslim countries spend more money on smoking and other tobacco use than on health promotion or education. The Qur&#8217;an deplores such waste: <em>Squander not your wealth senselessly. Squanderers are indeed the like of Satans (17.26, 27).</em></li>
<li>Smoking is had and impure, khabath. The Qur&#8217;an declares that the Prophet, upon him be peace, <em>forbids all that is bad and impure and allows all that is good and clean (7.157).</em> Smoking is bad and impure, as it Causes environmental pollution and is unpleasant, even seriously harmful, to those who do not smoke, injuring others is completely prohibited in Islam and considered one of the worst sins a believer can commit.</li>
</ol>
<p>There is a great need to inform Muslim communities about the legal opinions on tobacco use and the rationale for them. The Muslim governments should stand firmly against the pressures exerted upon them by the tobacco companies and their powerful Western backers. If Muslim countries and peoples adhere to the traditional religious lifestyles. They will succeed in avoiding the perils and tragic losses of life and wealth caused by tobacco consumption.</p>
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