Doctors are ethically obliged to advise patients to quit smoking

BMJ 1998; 317 doi: https://doi.org/10.1136/bmj.317.7172.1588 (Published 05 December 1998) Cite this as: BMJ 1998;317:1588
  1. Joseph L Y Liu, Research associate,
  2. Jin-Ling Tang, Associate professor
  1. Centre for Clinical Trials and Epidemiological Research, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong
  2. Department of Community and Family Medicine, Faculty of Medicine, Chinese University of Hong Kong

    EDITOR—Butler et al studied smokers and their perceptions of doctors' advice on quitting smoking1; their study concluded with a discouraging message for doctors who provide such advice. Doctors should consider other evidence when deciding whether to give advice to smokers on quitting. Contrary to Butler et al's findings, quantitative surveys have shown that most smokers want to be given advice about quitting.2 Even if the opinions of the smokers in this study are representative, we still believe that doctors should not be discouraged from giving advice on quitting.

    Advice from doctors is a cost effective intervention. Although brief advice enables only 2% of smokers to quit, it only costs £100 ($160) per success. This is 20 times more cost effective than nicotine replacement treatment (about £2000 per success).3 In high risk groups such as pregnant women, patients who have had a myocardial infarction, and men at high risk of ischaemic heart disease, the efficacy of brief advice is much greater.3

    The Framingham risk equation4 shows that the reduction in the risk of cardiovascular disease from quitting smoking is equivalent to the reduction in risk achieved by the combination of lowering blood cholesterol concentration by 30% and lowering diastolic blood pressure by 15 mm Hg. In practice, these targets are difficult and costly to attain; smokers are much more likely to require drug treatment to lower their blood pressure or cholesterol concentrations.5

    The management of risk factors in smokers, such as blood pressure and cholesterol, will impose a huge cost on the NHS and the taxpayer. By respecting patients' wishes not to be informed about quitting and by protecting the rights of smokers to continue smoking, which increases a society's burden of smoking related diseases, fewer economic resources will be available to non-smoking taxpayers, whose rights will therefore be infringed.

    Doctors have an ethical obligation to educate their patients about smoking and should not hesitate to routinely provide advice on quitting. The development of potentially better ways of giving advice, such as Butler et al's suggestion of tailoring advice to individuals, should be encouraged but these methods need to be tested for their efficacy and cost effectiveness.


    View Abstract