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LETTERS: William McKee, Michael McBride, Deirdre O'Brien, Antony Stevens, and Christine Burns Smoke free hospitals: Challenges need to be faced BMJ 2003; 327: 104 [Full text]

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When will the medical profession learn?

Paul Mcloughlin   (12 July 2003)

Smokeless Fumes

Seemit Dhage   (12 July 2003)

Rising to the challenge

Hayden McRobbie, Cressida Darwin and Peter Hajek   (14 July 2003)

Lighten up!

Mary J Curtis   (16 July 2003)

An Ill wind

Timothy B Webb   (16 July 2003)

When will the medical profession learn? 12 July 2003
Paul Mcloughlin, RN Kingston General Hospital, Canada Send response to journal: Re: When will the medical profession learn?	When will the medical profession admit that transferring the route of administration of nicotine ( or other addictive substances for that matter ) does not work? It is something cleverly introduced by drug companies to make money. Nicotine replacement therapy helps nobody but the suppliers and producers. 1)Abstinence from smoking eight years after participation in randomised controlled trial of nicotine patch Patricia Yudkin, Kate Hey, Sarah Roberts, Sarah Welch, Michael Murphy, and Robert Walton BMJ 2003; 327: 28-29 Competing interests:   None declared
Smokeless Fumes 12 July 2003
Seemit Dhage, Senior House Officer, Birmingham Send response to journal: Re: Smokeless Fumes	I think having smoke free hospitals is completely impractical. There are a couple of Smoking Free Hospitals in the country which claim that they are smoking free yet you will be surprised to see the number of people/paitients that one can come across smoking at every entry points in the hospital. Further from my personal experience, the more you take these things away from the patients and the public the more they become aware of it. Thus by prohibiting smoking or creating a smoke free environment we are actually constantly reminding people of their smoking habit. I feel the best option would be to create smoking zones/rooms in the hospital, while maintaing maximum isolation and let the smokers smoke in the rooms. I donot see any benefit of baning smoking in hospitals of any help in the near future.I also would like to point out that the main population that we are aiming towards in a less-smoke hospital environment is the non smoking patients rather than the already hooked on smokers who find quitting smoking difficult anyway. So lets aim at keeping smokers and non smokers away. Competing interests:   None declared
Rising to the challenge 14 July 2003
Hayden McRobbie, Research Fellow Barts and The London School of Medicine, Turner Street, London, E1 2AD, Cressida Darwin and Peter Hajek Send response to journal: Re: Rising to the challenge	EDITOR-Regarding W. McKee et al defence of the provision of rooms for smokers in response to M. McKee et al. editorial.1 2 The authors draw attention to the fact that for smoking cessation to be effective with inpatients, a follow-up of more than 4 weeks is needed. They argue that this cannot be provided in acute hospitals. The Royal London Hospital Inpatient Service provides an intensive behavioural intervention combined with nicotine replacement therapy and outpatient follow-up for at least 4 weeks. This is achieving four-week validated continuous abstinence rates of 54%. A growing number of acute hospitals within the UK are providing a similar cost-effective treatment.3 The £390,000 spent on the smoking rooms could have funded such a service for a very long time. Smoking rooms in hospitals also represent smoking cues and their existence may encourage smoking. Anecdotally, a number of patients we treated reported that the presence of smokers’ rooms sabotaged their quit attempts. Several years ago, separate funding was allocated to NHS smoking cessation services. In-patients represent one of their priority targets.4 Hospitals should be able to offer intensive smoking cessation treatment and follow-up via dedicated staff funded by the smoking cessation service, and the presence of such provision should make a transfer to smoke-free policies much easier. Hayden McRobbie research fellow h.j.mcrobbie@qmul.ac.uk Cressida Darwin research health psychologist Peter Hajek professor of clinical psychology Tobacco Dependence Research & Treatment Centre, Institute of Community Health Sciences, Barts and The London, Queen Mary’s School of Medicine & Dentistry, Turner Street, London E1 2AD 1. McKee W, McBride M, O'Brien D, Stevens A, Burns C. Challenges need to be faced. BMJ 2003;327:104. 2. McKee M, Gilmore A, Novotny TE. Smoke Free Hospitals. BMJ 2003;326:941- 2. 3. Darwin C, McRobbie H, Hajek P. Report of a National Meeting of Inpatient Smoking Cessation Treatment Providers. London: Barts and The London, Queen Mary's School of Medicine and Dentistry, 2003. 4. West R, McNeill A, Raw M. Smoking cessation guidelines for health professionals: an update. Health Education Authority. Thorax 2000;55(12):987-99. Competing interests:   None declared
Lighten up! 16 July 2003
Mary J Curtis, Head of Education & Training Mount Edgcumbe Hospice PL26 6AB Send response to journal: Re: Lighten up!	Editor We live in crazy times. The dept of Health and the medical profession spout some very strange ideas. Don't eat this, that or the other or this will happen to you - ah scary - Do this, that or the other, and if we don't like the look of you we won't treat you - ah scary. Sure, we are all going to die- what's your problem? You want us to look nice in the coffin when we start having open caskets just like the Americans? - as if we are not dead at all? Or perhaps you want to make sure the coffin is not too heavy - the person in it won't care, they'll be dead. Aghhh - that word we must hide from! After all, no one must die of anything that could be prevented. Is the aim to get us to live longer so that you can have the pleasure of giving us the lethal injection to finish us off when we are inconsiderate enough to live too long for your liking and you need the resources for your younger more fabulous healthy citizens??? Tut tut! The most interesting people in life are the so-called deviants. Lighten up the rest of you. Competing interests:   None declared
An Ill wind 16 July 2003
Timothy B Webb, Consultant anaesthetist Ysbty Glan Clwyd, Rhyl LL18 5UJ Send response to journal: Re: An Ill wind	Although I am as disgusted as anyone by the sight of patients outside the front door, drip in one hand fag in the other, despite the presence of a bus stop type smoking den being provided out the back, (convenient for the maternity unit,) I am pleased to note that the offenders are often patients recently operated upon. This ensures early exercise with leg movement and chest movement in an optimal position for deep breathing in relativly fresh air. I wonder if this may account for the apparent decrease in DVTs in smokers that, as I recall, has been reported by some. The exercise, presumably, has also a paradoxical improving effect on recovery. Only a realy addictive drug could do that. Much better to get them moving than fester flat in bed with a patch! This must be better than the old smoking room with its walls running with tar and nicotine. Competing interests:   Non Smoker who will leave a restaurant mid meal if someone starts smoking in kippering range.